Extensile medial parapatellar approach to the distal femur and knee

The Extensile Medial Parapatellar Approach to the Distal Femur and Knee: Anatomic Landmarks and Surgical Technique, Stevens, Jarrad; Clement, Nicholas, D.; Patton, James, T. Techniques in Orthopaedics (2018) published ahead of print.

Abstract:

This paper describes an extensile surgical approach to the distal femur, which incorporates the medial parapatellar arthrotomy. This extensile exposure serves as an anterior utility approach to the knee, allowing the surgeon access to all aspects of the anterior knee and near circumferential access to the distal femur. Reported indications for access to this region include: tumor resection, difficult primary arthroplasty and revision arthroplasty of the knee, and intra-articular and extra-articular fractures of the distal femur. Despite adequate working knowledge of the standard medial parapatellar approach to the knee, the extensile approach is seldom required and, as a result, orthopedic trainees and practising orthopedic surgeons may not be familiar with the musculotendonous junctions that occur in the quadriceps tendon. This report describes a novel surgical approach and the relevant anatomy through a series of detailed clinical and fresh cadaveric dissections. A previously undescribed anatomic landmark is demonstrated through photographs and cadaveric variation studies, which may help guide the surgeon in defining crucial planes.

fat-stripe-junction-vastus-medialis
The fat stripe (arrow) identifying the non-adherent junction vastus medialis and rectus femoris. FS indicates fat stripe; M, medial; P, proximal.

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