Recurrent lateral patellar instability can arise from several anatomical contributors, including trochlear dysplasia, patella alta, tibial tubercle lateralisation and insufficiency of the medial patellofemoral ligament. This systematic review and meta-analysis evaluated outcomes after isolated MPFL reconstruction, focusing on whether soft-tissue stabilization alone can restore acceptable function in carefully selected patients. The evidence suggests that isolated MPFL reconstruction can produce good stability and functional outcomes when major bony abnormalities do not require correction. The study is clinically important because it supports avoiding unnecessary combined procedures in appropriate patients while recognising that patient selection is critical. Surgeons should assess patellar height, TT-TG distance, trochlear morphology, rotational alignment and the pattern of instability before deciding that isolated reconstruction is sufficient. The broader message is that instability is a three-dimensional problem: the MPFL is central, but reconstruction should not be used to mask unaddressed structural drivers. Rehabilitation, graft placement and prevention of stiffness also matter. For HCPs, the paper supports an anatomy-led strategy in which isolated MPFL reconstruction is reserved for patients whose instability profile can reasonably be corrected without adding tibial tubercle osteotomy or trochleoplasty.