Surgical technique of the midvastus arthrotomy.

For more than 25 years most surgeons have used a medial parapatellar surgical approach for total knee arthroplasty because this technique affords simplicity and excellent exposure to all compartments of the knee. This article describes how the midvastus muscle splitting approach achieves surgical exposure equivalent to that of the standard medial parapatellar approach, while preserving the integrity of the vastus medialis insertion into the medial border of the quadriceps tendon. This total knee arthroplasty approach divides the vastus medialis muscle in the direction of its fibers, as opposed to the traditional method of splitting the quadriceps tendon above the patella. The limited disruption of the extensor mechanism improves the rapid restoration of quadriceps muscle control. In addition, a more stable patellofemoral articulation is evidenced by a marked reduction in the need for lateral retinacular releases.