Patient has 5 recurrent lateral patellar dislocations and undergone previous arthroscopy. Longitudinal anterior incision was made dissecting down to the soft tissues from the quadriceps tendon, patellar tendon and distal tibia. Thick flaps were raised exposing both the medial lateral retinaculum. An initial incision was made along the lateral retinaculum in a Z-plasty type fashion. The anatomy was somewhat disrupted and felt to probably be scarred from a previous arthroscopic lateral release. However, best attempt was made to do a Z-plasty indentifying the soft tissues and allowing layer lengthening. Palpation was done to feel the vastus lateralis tendon and not the incisor. The medial retinaculum was then incised using approximately 5mm cuff of tissue leaving this on the patella. It was everted and the medial edge of the patella was ronguered to expose bone. THe patellar tendon was then isolated both medially and laterally. Bovie was then utilized on the tibia to draw the planned osteotomy. With protection of the patellar tendon, a saw was utilized from medial to lateral once the lateral anterior compartment retinaculum and fascia was incised. It was protected with a malleable. The osteotomy was then performed in a relatively flat manner while cutting from medial to lateral. A small hinge of bone was left distally. It was then medialized approximately 9mm. It was kept in place with two 0.062 K wires placed from anterior to posterior and the knee was ranged. This was felt to be excellent tracking. With the knee in straight position, the K wires were sequentially removed, drilled with a 0.045, followed by bicortical 0.032 drill. They were measured and screws placed bicortical and compression lagging fashion. Fluoroscopic guidance ws utilized to perform this and final pictures confirmed excellent positioning. This allowed a 9mm medialization. The medial patellofemoral ligament was then repaired in a pants-over-vest fashion bringing the lateral aspect underneath the medial tuft and abutting against medial bone in the patella. This was repaired with #2 Ethibond suture. Using 2-0 vicryl, a running baseball stitch was then performed all the way down the medial retinaculum for reinforcement and to make a smooth surface. The lateral retinaculum was then addressed. The Z-plasty was then repaired in a side-to-side fashion perfoming the lengthening. The anterior compartment fascia ws repaired, wound copiously lavaged multiple times. Following this skin was closed etc.