Comparison of the Vastus-Splitting and Median Parapatellar Approaches for Primary Total Knee Arthroplasty: A Prospective, Randomized Study

Abstract

The vastus-splitting approach offers a viable alternative to the median parapatellar approach for primary total knee arthroplasty that reduces the need for lateral retinacular release without impairment of quadriceps function. Electromyographic abnormalities in the quadriceps muscle have no functional consequence and most likely represent reversible neurapraxic injury that may be avoided by blunt dissection in the vastus medialis muscle.

Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique

“…The lateral release rate was lower when a midvastus arthrotomy was used (5%) compared with a medial parapatellar arthrotomy (13%). Kelly et al [18] and Engh et al [8] reported similar findings (Table 6). With a midvastus arthrotomy, the pull of the still-attached vastus medialis negates the pull of the laterally attached vastus lateralis and rectus femoris.…”

“…Patellar maltracking can be dealt with in several ways at surgery. Lateral release of the tight lateral retinaculum is one well-described option in the literature [14,34] and has been reported as being performed in 3.8% to 45% of patients [18][19][20][21]37]. Complications include patellar avascularity [24,31,36] and patellar fracture [29,31,35].…”

Comparison of the Minimally Invasive and Standard Medial Parapatellar Approaches for Total Knee Arthroplasty: Systematic Review and Meta-Analysis

“…Another study that compared electromyographic differences between the two vastus-splitting approaches was also excluded from the analysis. 25 Further investigations are required to improve understanding of the differences between the three minimally invasive approaches. Also, the QS approach should be studied to facilitate further critical comparison between different minimally invasive approaches and versus the MP approach.…”

An unusual management of advanced gonarthrosis: total knee arthroplasty with posterior approach

“…Kuadriseps tendonunda kesi yapılması ve bu kesinin medialde patellaya oldukça yaklaşarak patellanın dolaşımını negatif yönde etkileyebilmesi bu yaklaşımın olumsuz yönleridir. [9,10] İkinci sıklıkta uygulanan subvastus yaklaşımda vastus medialis kasının medial tarafından altına girerek dizin ekstansör mekanizmasına zarar vermeden diz eklemi ortaya konulabilmektedir. Ekstansör mekanizmaya zarar vermemesi ve patellanın dolaşımını koruması olumlu yönleridir.…”