Patellofemoral instability is a complex anatomical phenomena that requires deep understanding. The cause for instability could be a result of an anatomical defect or a soft tissue pathology. A thorough patient history, physical examination and imaging are paramount for a correct diagnosis and for deciding on the correct treatment. The proper treatment is often debatable. Conservative treatment is suitable for acute dislocation but has a high failure rate in chronic instability, which usually necessitates surgical treatment. The common surgical treatments today focus on fixing anatomical defects, relieving patients' symptoms of instability and giving them the opportunity to return to the level of activity suitable for them. In this literature review we summarize the relevant anatomy, biomechanics, clinical evaluation and treatment options for patellofemoral instability.