Authors of section

Author

Denis Marcellin-Little

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 patella. It may be preferred for fractures where the fixation will originate in the medial aspect of the patella.
Medial parapatellar approach

2. Anatomy

Key anatomic landmarks to be identified prior to the surgical approach include:
  • Patella
  • Patellar ligament
  • Femoral trochlea
The patellar fragments should be identified to avoid damaging them during the approach.
Anatomic landmarks for medial parapatellar approach

3. Skin incision

An incision is made from the distal third of the femur to the proximal tibia, parallel and just medial to the patellar tendon distally.
Medial parapatellar incision

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 ligament and the patella.
The fascia is retracted caudally.
Medial fascia opening
A stab incision is made into the joint capsule 2-3 mm medial to the patella. The incision is extended proximally to the vastus medialis and distally to the tibial tubercle using scissors, making sure that sufficient tissues are left adjacent to the patella for closure of the joint capsule.
Note: Damaging the articular surface should be avoided.
Stab incision
Pearl: Grasp and tension the joint capsule with forceps prior to the stab incision to avoid damaging the underlying articular cartilage of the femoral trochlea.
Stab incision
With the stifle in extension the articular surface of the patella is exposed and inspected.
Patellar surface exposure and inspection

5. Closure

The joint capsule is closed using absorbable sutures. The medial fascia of the stifle joint is closed in an appositional pattern. Subcutis and skin are routinely closed.