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Nine randomized controlled trials comprising of1569 patients undergoing primary total knee arthroplasty (TKA) had two groups; one whom 773 (49%) patients underwent patella resurfacing and another group with 796 (51%) patients who did not. All included studies had a minimum follow-up of two years (mean 6.4 ± 2.5 years). The outcomes were the incidence of extensor mechanism disruption–related complications (patellar fracture, quadriceps tendon tear, patellar tendon tear) and the need for surgical intervention for extensor mechanism disruption. Overall, the results demonstrated that extensor mechanism disruption after TKA was rare (overall incidence 0.4%), and patella resurfacing was not associated with an increased risk of extensor mechanism disruption or surgery for extensor mechanism disruption compared with nonresurfacing. These findings suggest that concerns about extensor mechanism failure should not be a primary determinant when deciding whether to resurface the patella during TKA.