148 patients undergoing total knee arthroplasty without patellar resurfacing for degenerative osteoarthritis were randomized to either receive lateral retinacular release or not, to compare the incidence of anterior knee pain between treatment groups. Upon study completion, routine lateral retinacular release significantly lowered the incidence of anterior knee pain and patellar malposition compared to the control group, while postoperative knee scores, function scores, patellar scores, patient satisfaction, and complications did not significantly differ between groups after 18 months.