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Patellar dislocations in children and youth are estimated to occur in 29 of 100,000 individuals. Recurrent patellar dislocations in the skeletally immature patient are often associated with distinct pathoanatomies, which include patella alta, trochlear dysplasia, and contractures of the central and/or lateral structures of the extensor mechanism. This paper discusses the features of patellar instabilities classified as traumatic versus atraumatic, congenital versus acquired, and fixed dislocations versus habitual dislocations. Suggestions for the surgical management of these various classifications of patellar instabilities, on the basis of the principle of identification and correction of the pathoanatomies unique to the individual, are provided.