Historically, anatomic factors have been identified that increase one’s risk for episodic lateral patella dislocations. A surgical treatment algorithm has been proposed which utilizes these risk factors. This algorithm depends primarily on realignment of the bony architect. Increasingly, the soft tissue retinacular restraints have been shown to be important as an anatomic factor critical for patellofemoral stability; in particular, the medial patellofemoral ligament (MPFL) has been recognized as the essential stabilizer against lateral patella displacement. Current indications for MPFL reconstructions will be reviewed. The frequency of reconstructing the MPFL alone versus combining it with other realignment schemes in my last 30 patients will be presented.