Knee – medial parapatellar approach

* position – supine & tourniquet

* incision – vertical, midline, centered over patella to just med. to tibial tubercle

* no internervous plane

* dissection
– incise subcut. tissue to expose parapatellar retinaculum
– raise small medial flap of skin & subcut. tissue
– incise joint capsule extending from quads tendon to med. parapatellar retinaculum to med. to tibial tubercle
– if not doing TKA, beware of ant. horn of med. meniscus at joint line
– dislocate patella lat. & evert
– flex knee to 90 deg.
– joint fully exposed

* dangers
– infrapatellar branch of saphenous n. – usu cut during this exposure; risk of neuroma
– patellar tendon – problem if it avulses from tibia

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