Lateral patellar instability is a common orthopaedic condition characterized by lateral subluxation or dislocation of the patella (1). Instability events can be characterized on a spectrum from acute traumatic dislocations to recurrent subluxations or dislocations. The exact etiology of patellar instability is multifactorial; however, it is understood that the medial patellofemoral ligament (MPFL) is the most important restraint to lateral patellar displacement from zero to thirty degrees of knee flexion (2,3, 4,5). It has also been shown that incompetence of the MPFL is the characteristic lesion in recurrent patellar instability (6). As a result, reconstruction of the MPFL ligament has become the preferred surgical treatment for this condition (7,8). MPFL reconstruction can be performed in isolation or in concert with a variety of additional surgical procedures to correct soft tissue imbalance or bony malalignment (9,10). These procedures include, but are not limited to, tibial tubercle osteotomy and trochleoplasty (11,12, 13). The indications and techniques for these concomitant procedures are variable from surgeon to surgeon and remain an area of ongoing discussion (14,15). Similarly, a variety of surgical techniques have been described for MPFL reconstruction (16,17, 18,19, 20). The goal of this paper is to describe the theory, indications, and technical details of our preferred surgical technique for management of lateral patellar instability.