The medial patellofemoral ligament has been recognized as the most important medial structure preventing lateral dislocation or subluxation of the patella. Numerous surgical techniques have been described to reconstruct this important structure in patients with patellofemoral instability. This paper reviews the relevant anatomy and biomechanics, published reconstruction options, and describes the surgical technique used at our institution using semitendinosus autograft to reconstruct the medial patellofemoral ligament.