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.
Key anatomic landmarks to be identified prior to the surgical approach include:
The patellar fragments should be identified to avoid damaging them during the 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.
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.
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.
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.
With the stifle in extension the articular surface of the patella is exposed and inspected.
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.