ObjectiveTo report successful surgical repair of a grade IV lateral patellar luxation in a 437‐kg heifer.Study DesignCase report.AnimalSeventeen‐month‐old Holstein heifer (437 kg).MethodsDiagnosis of traumatic lateral patellar luxation was made based on physical examination, and confirmed on radiographs. Arthroscopic examination of the stifle assessed joint changes. Lateral patellar luxation was surgically repaired using lateral release of the patella and medial imbrication of the joint capsule.ResultsThe heifer presented nonweight‐bearing lameness of the left hind limb (5/5 lameness score). Unilateral grade IV lateral patellar luxation was diagnosed based on physical examination and radiography. Arthroscopic examination of the stifle showed synovitis and cartilage eburnation of the medial articular surface of the patella and of the lateral trochlear ridge of the femur. Lateral release of the patella and medial imbrication of the joint capsule was performed. The heifer remained lame (4.5/5 lameness score) and developed severe disuse muscle atrophy after surgery. By day 112, the heifer was walking easily and was completely weight bearing on the left hindlimb but did have a gait alteration (2/5 lameness score). On day 229, the heifer calved for the first time and lameness was no longer evident.ConclusionThis report documents successful surgical treatment of traumatic lateral patellar luxation in a large heifer but additional case evaluation is required to provide an accurate prognosis for this condition and treatment in large cattle.