The right surgery for recurrent patellofemoral instability remains a topic of controversy.  While medial patellofemoral ligament reconstruction (MPFLr) is the standby surgical procedure for this condition, many adjuncts including tibial tubercle osteotomy (TTO) are performed concurrently with the hope of improving the chances of success.  Historically, a tibial tubercle-trochlear groove (TT-TG) distance greater than 20 mm has triggered surgeons to perform TTO, however recent evidence suggests this may be unnecessarily aggressive.  We welcome Dr. Mininder Kocher, MD, MPH from Boston Children’s and Harvard Medical School to discuss his study evaluating the outcomes of MPFLr alone versus MPFLr + TTO in patients with recurrent patellofemoral instability with a tibial tubercle-trochlear groove (TT-TG) distance greater than 20 mm.