Objective To observe the clinical effect of arthroscopic release of lateral patellar retinaculum plus tranexamic acid on excessive lateral pressure syndrome. Methods A total of 100 patients with excessive lateral pressure syndrome admitted from April 2018 to March 2021 were selected as study subjects, and divided into a routine group and a combined group by random number table method, with 50 cases in each group. The routine group was treated by release of lateral patellar retinaculum under arthroscopy, while the combined group received release of lateral patellar retinaculum under arthroscopy plus tranexamic acid treatment. The two groups were compared in preoperative and 1-month postoperative hemoglobin （Hb）, D-dimer, and Visual Analogue Scale （VAS） score, as well as postoperative knee last knee diameter and incidence of thrombosis of lower limbs. Results At 1 month after operation, compared with the routine group, the levels of Hb and D-dimer in the combined group were higher, the VAS score of the combined group was lower, and the knee diameter of soft tissue ecchymosis was shorter than that of routine group（P<0.05）, and the incidence rate of lower limb thrombosis in the combined group （0.00% vs. 10.00%） was lower （P<0.05）. Conclusion Arthroscopic treatment of lateral patellar retinaculum combined with tranexamic acid for excessive lateral pressure syndrome can effectively elevate the levels of Hb and D-dimer, relieve pain, reduce ecchymosis, and decrease the incidence of lower limb thrombosis.