This video describes the surgical technique for iliotibial band Z-plasty lengthening. Iliotibial band friction syndrome and the most common open surgical techniques for iliotibial band elongation are discussed. The video includes a discussion of the preoperative plan, surgical approach, iliotibial band Z-plasty, bursectomy, tenorrhaphy, passive motion testing, closure, and postoperative rehabilitation protocol. The postoperative results of a case series of four patients (five knees), one of whom was a runner and three of whom were mountaineers, who underwent iliotibial band Z-plasty lengthening after failed nonsurgical treatment are presented. The mean Lysholm knee scale score increased from 84 preoperatively to 99 postoperatively. One patient had a wound granuloma, but no other complications were observed. All the patients returned to full sports activity between 3 to 6 months postoperatively. To the authors’ knowledge, this is the first intraoperative surgical demonstration of iliotibial band Z-plasty lengthening.