Patellar instabilities are the most common knee pathologies during growth. The management of this condition can be difficult for the surgeon, so a comprehensive understanding of the anatomy and biomechanics of the structures around the knee plays an important role in creating the right treatment plan. Trochlear and patellar morphological abnormalities, ligamentous stabilizers, extremity disorders in the axial plane, and patellar height abnormalities are among the predisposing factors. Traditionally, the first dislocation is treated conservatively; however, recent studies suggest that certain factors are associated with recurrent instability and surgical treatment can be considered even for the first dislocation. It should be noted that some surgical techniques cannot be applied to children with open physes. In this review, we emphasized the importance of individualization of treatment methods and treatments in pediatric and adolescent patellofemoral instabilities in line with the latest information.