Based on history and xrays the likely original injury was a patella dislocation. Initial treatment is typically non op with about a 50/50 chance of surgery. The ligament in question is the medial patellofemoral ligament or mpfl. Yours does not work hence why The patella is lateralized. The problem long term is either instability where the patella can repeatedly dislocate or development of cartilage wear and arthritis leading to pain. Unfortunately I’ve seen several patients with similar issues present years after initial injury. Options become quite limited.
If the option is tightening meaning they plan on just putting some suture in and trying to tighten the medial side you should find a different surgeon. Realistically depending on cartilage you may need a reconstruction of the ligament and possibly a realignment of the tubercle where your patella attaches. I obviously can’t make official recs but this is the common situation.
Based on X-ray if this is not addressed early arthritis is a likely scenario.