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Primary patellar dislocation continues to be a common problem facing clinicians today. These injuries are associated with significant morbidity and a substantial recurrence rate. A myriad of operative and nonoperative options have been described to treat these injuries though the evidence-based literature is sparse. As a result, much controversy exists regarding the ideal management of the primary patellar dislocation. This article reviews the literature on this topic, from the initial examination and management to definitive treatment. Furthermore, an algorithm is presented to help the clinician approach and treat these patients.