90 patients undergoing primary total knee arthroplasty with patellar resurfacing were randomized to receive patellar resurfacing with either the use of a standard cutting guide or freehand resection with either haptic feedback or the novel four-quadrant technique. The purpose of this randomized controlled trial was to determine how accurate and efficient these three techniques were in terms of symmetrically resurfacing the patella and to analyze the efficacy of a surgeon's preferred technique compared to novel techniques. The results suggested that patellar resection with the four-quadrant technique resulted in the most symmetrical resections and both freehand techniques displayed more accurate achievements of goal thickness of the patella when compared to the use of a standard cutting guide. Surgeon's preferred techniques were similar to novel techniques in terms of patellar asymmetry and in achieving goal thickness.