Authors of section

Author

Mary Sarah Bergh

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Medial parapatellar approach

1. Indications

The medial parapatellar approach provides adequate visualization of the articular surface of the femoral condyle and allows access for implant placement in this region. It may be preferred for fractures of the medial condyle.

The dog medial parapatellar approach provides adequate visualization of the articular surface of the femoral condyle

2. Anatomy

Key anatomic landmarks to be identified prior to the surgical approach include:

  • Patellar tendon
  • Medial collateral ligament
  • Articular surface

Depending on the fracture type, these landmarks may be displaced. Care should be taken to identify and avoid damage to them during the approach.

Key anatomic landmarks to be identified prior to the medial parapatellar approach to the dog distal femur

3. Skin incision

A parapatellar incision is made from the distal third of the femur to the proximal tibia.

Incision for medial parapatellar approach to the dog distal femur

4. Exposure

The subcutaneous tissues are incised along the same line and retracted.

The medial fascia is incised cranial to the sartorius muscle. The incision is extended distally across the stifle joint 2-3 mm medial to the patellar tendon.

The fascia is retracted caudally.

Fascia incision for medial parapatellar approach to the dog distal femur

A stab incision is made into the joint capsule adjacent the patella. The incision is extended proximally and distally using scissors.

Note: Damaging the articular surface should be avoided.

Capsule incision for medial parapatellar approach to the dog distal femur

Note: Grasp and tent the joint capsule with forceps prior to the stab incision to allow more room between the scalpel blade and articular cartilage.

Grasp and tent the joint capsule with forceps prior to the stab incision for medial parapatellar approach to the dog distal femur

With the stifle in extension the patella is luxated laterally for exposure of the articular surfaces of the distal femur. Retraction of the infrapatellar fat pad may be helpful to inspect the joint thoroughly.

Exposure of the articular surfaces for medial parapatellar approach to the dog distal femur

5. Closure

The joint capsule, and the medial fascia is closed in an appositional pattern. Subcutis and skin are routinely closed.