Although patients with patellofemoral instability report satisfaction at long-term follow-up that the patella is no longer dislocated after surgery. However, many patients with preoperative severe lower extremity bony deformities continue to experience progressively worse symptoms after surgery, such as painful movement, popping, swelling after activity, and joint pain during weather changes. Is the long-term outcome of patients treated with different surgical approaches for patellar dislocation the same? The authors first hypothesized that as long as the abnormal lower extremity force lines were corrected and the patellar fracture was improved, the surgical results would be the same regardless of the surgical approach. Twenty-five patients with both patellar dislocation and significant lower extremity deformity were selected. Significant lower extremity deformity was defined as femoral-foot angle greater than 30° and patellar ligament angle to the vertical line greater than 10°. All patients were divided into 2 groups: 13 patients in group 2 between 1998 and 2002 underwent internal tibial stop migration, and 12 patients in group 1 between 2002 and 2005 underwent proximal tibial rotational osteotomy. All 25 cases were followed up prospectively for at least 24 months. The follow-up included a physical examination, functional questionnaires, radiographs and CT axial films, and a three-dimensional gait analysis of both lower extremities using a three-dimensional mechanics runner to collect data on standing kinematics, foot advancement angle, knee flexion angle, knee valgus angle, hip flexion angle, and patella angle, with the corresponding data on the healthy side as a control. Through the observation, the authors found that the patients in group I had a greater improvement in both subjective sensation and physical and auxiliary examinations after surgery than before surgery. The patients in group II showed improvement, but not as significant as group I. There was a significant difference between the two. Gait analysis also showed that patients in group I had a more symmetrical gait, while patients in group II had a greater gait abnormality. Finally the authors concluded that the initial hypothesis was not correct. Intraoperative soft tissue balancing of the lower extremity, correction of the angle of the patellar ligament to the vertical line and rotational deformity of the lower extremity and conservative internal displacement of the tibial stop alone were much more effective.