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Patella instability post total knee arthroplasty (TKA) is a rare complication. Tibial tubercle osteotomy (TTO) with medial patellofemoral ligament reconstruction (MPFLr) has not been well described for this indication. This paper describes a surgical technique to address the unique challenges faced when performing TTO and MPFLr in the prosthetic knee. This technique and video describe a TTO and MPFLr via an extensile incision and medial sub-vastus approach. A 6cm long TTO is performed, if indicated, to medialise the extensor mechanism u
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