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In the present study, a significantly higher rate of lateral release was demonstrated in the patients with patellar fractures despite the relative high overall lateral release rate (82%). Although the complication of patellar fractures in total knee arthroplasty has a multifactorial etiology, these findings implicate lateral retinacular release as a significant factor. It is unclear whether the lateral retinacular release was a direct result of the surgical technique or whether it was necessitated by the anatomy of the patellofemoral articulation in this component system. Lateral release may continue to be performed as needed during total knee arthroplasty to maintain optimal patellofemoral mechanics. However, if it is performed, an attempt should be made to preserve the lateral superior genicular artery.