Many procedures have been described for the treatment of patella instability. However, based on anatomic and imaging studies, the primary injury in patients with patella dislocation is disruption of the medial patella femoral ligament. Based on these studies and clinical results, proximal realignment by reefing the stretched medial structures seems to be the most rational approach for most patients with patella instability. Although open proximal realignment techniques have been reported, there is an advantage to less invasive arthroscopic techniques that limit postoperative scar tissue and allow more rapid rehabilitation. In addition, arthroscopic realignment offers the ability to adjust or titrate the realignment under direct vision to optimize tracking and avoid overcorrection. After reviewing the literature and indications for surgery in this article, we describe our technique for arthroscopic realignment and present our results. At 5-year follow-up, 93% of patients reported significant subjective improvement. The mean Lysholm score improved from 41.5 to 79.3 (P < 0.05). Preoperative and postoperative radiographs were measured for congruence angle, lateral patellofemoral angle, and lateral patella displacement, and all showed significant improvement postoperatively (P < 0.05; Figs. 4-6). There were no complications and redislocations.