Congenital patellofemoral pathologies may develop both in anatomically normal knees and dysplastic knees. Congenital dislocation of the patella which is present at birth is a disorder preventing extensor mechanism from functioning properly. Early treatment of congenital dislocation of the patella before secondary bone deformities develop is of utmost importance. Duplication of the extensor mechanism is one of the rarely seen congenital disorders of patellofemoral joint. For the treatment, hypoplastic segment is incised and remaining dominant extensor mechanism is centralized and reconstructed. Nail-patella syndrome is another genetic disorder, usually presenting with patellofemoral involvement. The disease is characterized by abnormalities of the nails, hypoplasia or the absence of the radial head, iliac horns at the posterior or adjacent iliac crest. Other patellofemoral disorders include patellar instability due to Down`s syndrome and multi-fragmented fracture of the patella. Multiple patellar ossification centers in the superior and lateral quadrants of patella, particularly, are frequently seen.