The medial quadriceps tendon femoral ligament (MQTFL) reconstruction is an alternative to the patellar bony fixation of the medial patellofemoral ligament reconstruction for the treatment of lateral patellofemoral dislocation. We describe the first report of a unique application of this technique in a patient with a previous patellectomy to treat a dislocating quadriceps tendon. An active 59-year-old Caucasian man presented 25 years after patellectomy with a dislocating quadriceps tendon and significant dysfunction. Stabilization of the knee extensor mechanism with an MQTFL reconstruction and retensioning of the quadriceps complex by tibial tubercle distalization provided stability and improved function. Extensor tendon instability is a rare complication after patellectomy that can cause significant pain and dysfunction. Successful stabilization of the quadriceps mechanism through an MQTFL reconstruction can provide excellent patient satisfaction and functional results. This technique may have implications for patellofemoral instability surgeries and in cases of knee extensor dysfunction after total knee arthroplasty.