The medial patellofemoral ligament (MPFL) is an important stabilizer that plays a role in keeping the patella in the trochlear groove and preventing its lateral displacement. This ligament is almost always injured after the first dislocation. The medial patellofemoral ligament reconstruction is currently a widely accepted treatment modality for the treatment of patellofemoral instability. Different graft selections and fixation methods are used for reconstruction. The origin of the graft should be located at the Schöttle point on the medial condyle of the femur, and its insertion should be located 1/2 proximal of the medial edge of the patella. Distal realignment procedures are recommended in addition to MPFL reconstruction in patients with malalignment such as increased Q angle, trochlear dysplasia, and increased tibial tubercle-trochlear groove distance. For realignment, medialization of the tibial tubercle with different surgical methods has been described in patients without patellofemoral arthrosis and anterior knee pain. Elmslie-Trillat osteotomy is a medialization method that is frequently used today and has good functional results. Anteromedialization of the tibial tubercle -Fulkerson`s osteotomy- is preferred in patients with patellar chondromalacia findings in addition to patellar instability findings.