For lateral retinaculum (LR) tightness, release or lengthening is the indicated surgical correction. LR release (LRR) or lengthening (LRL) may be a primary treatment for painful lateral compression syndrome or as an adjunct treatment in the setting of patellofemoral instability. Although it is challenging, assessment of the soft-tissue balance between the medial restraint (the medial patellofemoral ligament) and the lateral restraint (the lateral retinaculum) is fundamental to a good outcome. LRR and LRL are effective in the treatment of patellofemoral disorders in which lateral tightness is part of the pathology. Understanding the indications for treatment is essential. Although both procedures have standard postoperative complications, LRL as an alternative to LRR maintains lateral soft-tissue integrity and avoids iatrogenic medial patellar laxity, which is a serious complication with LRR. For these reasons, we recommend using LRL to address LR tightness in patellofemoral disorders.