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» The optimal management of the patella during total knee arthroplasty (TKA) remains a controversial topic with no consensus. » Patellar management techniques during TKA include patellar retention or resurfacing with or without patellaplasty, as well as circumferential denervation and partial lateral facetectomy (PLF). » Special considerations such as patient age, etiology of disease, implant design, and surgeon preference should be accounted for when determining optimal management. » We recommend that most patellae be circumferentially denervated, regardless of whether they are resurfaced, as the potential benefits outweigh the small associated risks. » Evidence demonstrates improved functional outcomes with the addition of PLF to nonresurfaced patellae. There is currently a paucity of evidence of this technique with respect to resurfaced patellae. » Patellar resurfacing adds additional costs and health-care resources that should be considered in the decision-making process.