Background/aim: Multiple reconstruction techniques have been described to mimic the normal anatomy and physiology of medial patellofemoral ligament (MPFL) reconstruction. The success of MPFL reconstruction depends on various factors such as graft selection, the location of the patellar tunnel and femoral tunnel (FT), and graft fixation methods. The aim of this study was to analyze the relationship between FT location and functional and clinical outcomes after MPFL reconstruction. Materials and methods: The midterm clinical results of patients who underwent MPFL reconstruction for patellofemoral instability in a single institution between 2013 and 2019 were evaluated retrospectively. If the FT was within the 6-mm-diameter reference circle, the center of which is Schottle’s point, the tunnel was accepted as anatomical; otherwise, it was considered a nonanatomical tunnel. The functional outcomes of the patients in both groups were evaluated with Kujala, Tampa kinesiophobia, and visual analog scale (VAS) pain scoring. Results: A total of 34 patients, 23 female (67.6%) and 11 male (32.4%), were evaluated. The mean follow-up period was 48.92 ± 2.93 (months). Tunnel position was anatomical in 22 patients (64.7%) and nonanatomical in 12 (35.3%). The postoperative VAS pain scores of those in the anatomical tunnel group were significantly lower than those in the nonanatomical tunnel group (p = 0.015). There was no statistically significant difference between the groups in terms of Kujala or Tampa kinesiophobia scores (p > 0.05). Conclusion: Although FT placement did not affect functional scores in MPFL reconstruction in this study, malpositioning of the FT is associated with a higher postoperative VAS pain score.