A Comparison of the Vastus Splitting and Median Parapatellar Approaches in Total Knee Arthroplasty

Parentis, Michael A.; Rumi, Mustasim N.; Deol, Gurvinder S.; Kothari, Milind J.; Parrish, William M.; Pellegrini, Vincent D.

doi:10.1097/00003086-199910000-00013

Cited by 67 publications

(42 citation statements)

References 17 publications

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“…17 Parentis et al 18 noted electromyographic abnormalities in vastus medialis in patients undergoing the midvastus approach in 43% of cases compared with none in the medial parapatellar group. Keating et al 19 in a randomized prospective trial reported no differences in range of motion, straight leg raise, and requirement for lateral releases in a series of 100 patients.…”

Section: Midvastus Approachmentioning

confidence: 99%

“…The authors did not recommend the approach as being superior to the medial parapatellar approach. Less blood loss 18 and fewer intraoperative lateral releases have been reported. [17][18][19] There have been equivocal opinions regarding the use of midvastus approach in patients with difficult access.…”

Section: Midvastus Approachmentioning

confidence: 99%

“…Less blood loss 18 and fewer intraoperative lateral releases have been reported. [17][18][19] There have been equivocal opinions regarding the use of midvastus approach in patients with difficult access. 19,20 Advocates of this approach believe that it is easier to evert the patella with the midvastus approach than with the subvastus approach because of the reduced bulk of the vastus medialis.…”

Section: Midvastus Approachmentioning

confidence: 99%

See 2 more Smart Citations

RETRACTED: Surgical approaches for total knee arthroplasty

Vaishya

Vijay

Demesugh

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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Section: Midvastus Approachmentioning

confidence: 99%

Section: Midvastus Approachmentioning

confidence: 99%

Section: Midvastus Approachmentioning

confidence: 99%

See 1 more Smart Citation

RETRACTED: Surgical approaches for total knee arthroplasty

Vaishya

Vijay

Demesugh

et al. 2016

Journal of Clinical Orthopaedics and Trauma

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“…The medial parapatellar incision and closure can affect patellar tracking in total knee replacement surgery, explaining the differing lateral retinacular release rates in total knee replacement in the literature for different approaches to the knee. [14][15][16][17] Similarly, this may be the cause for the different recommendations that have been made regarding how the medial parapatellar incision should be addressed during the assessment of patellar tracking, ranging from not placing pressure on the patella and leaving the incision open to approximating the capsular incision in two locations. [18][19][20][21][22][23][24] The patellar split is relatively easy to perform.…”

Section: Discussionmentioning

confidence: 99%

The transpatellar approach for the knee in the laboratory

Merican

Ghosh

Deehan

et al. 2009

Journal Orthopaedic Research

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This paper describes a longitudinal patellar-splitting approach to the knee that includes provision for accurate reconstruction. Our in vitro experiments showed that patellofemoral kinematics and length-change patterns of specific bands of the peripatellar retinacula were not changed significantly by opening and closing the knee via the transpatellar approach. This surgical approach will be useful for in vitro experiments on the knee, when effects due to alterations of internal structures such as cruciate ligament reconstructions or joint replacement are to be studied, avoiding confounding effects caused by changes to the retinacula. In the past, the patellar splitting approach was considered a reasonable option for gaining wide exposure of the knee. Insall credited Sir Robert Jones for the patellar splitting approach.1 In 1971, Insall modified this incision to retain inherent advantages of excellent exposure, but eliminate the disadvantages of splitting the patella.1 His incision elevated the soft tissue overlying the patella, but distally still split the patellar tendon. Splitting the patella was used in case reports for osteochondritis dessicans 2 and exploration and meniscectomy.3 Henderson 4 utilized the incision to obtain good exposure for difficult cases in removal of loose bodies. 5 In pediatric physeal fractures of the distal femur, he recognized the importance of accurate reduction of the articular surface, and therefore did not hesitate to perform a wide exposure by splitting the patella.6 However, around the same time, the medial parapatellar approach was described to gain adequate exposure of the knee without splitting the patella. 7 We are involved in biomechanical work to characterize changes in kinematics and ligament length as a result of surgical intervention and prosthesis geometry. So as not to change the properties of the extensor retinacula, we explored the utility of the patellar splitting approach for laboratory use. Our aim here was to verify that significant changes in kinematics and length changes of the attachments of the extensor retinacula (the lateral retinaculum and the medial and lateral patellofemoral ligament) did not occur with a patellar splitting approach. Our hypothesis was that a longitudinal patellasplitting approach allows adequate access to the knee but does not impact patellofemoral kinematics or the extensor retinacula length. MATERIALS AND METHODS Specimen PreparationNine fresh-frozen cadaveric knees (mean age ¼ 64 years, SD ¼ 16 years) were obtained from the International Institute for the Advancement of Medicine (Jessup, PA). The institute undertook screening and consent for their use for research. Ethical permission for the study was obtained from the Riverside Research Ethics Committee. The knees were stored at À208C and thawed a day prior to experimentation.The skin and subcutaneous tissue were removed. The deep fascia, retinacula, and iliotibial band (ITB) were preserved. The femur and tibia were cut approximately 20 and 15 cm above and below the knee...

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“…The authors did not recommend the approach as being superior to the medial parapatellar approach. Less blood loss (Parentis 1999) and fewer intraoperative lateral releases (Maestro 2000;Parentis 1999; White 1999) have been reported. Engh 1998 suggested the midvastus approach is contraindicated in patients with anticipated difficult access while White 1999 argued the exposure was no more difficult than for the medial parapatellar approach.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%