The mini-subvastus approach for total knee arthroplasty

The mini-subvastus approach to the knee is a reliable, reproducible, and safe way to access the knee joint. Contrary to other approaches, the subvastus is the only approach that maintains the integrity of the entire extensor mechanism. Other common approaches, such as the medial parapatellar, midvastus, and quadriceps sparing approaches, violate some portion of the quadriceps tendon. The level of the distal-most attachment of the vastus medialis obliquus (VMO) is at the midpole of the patella (1). Therefore, any approach that extends proximally to the midpoint violates a portion of the quadriceps tendon and should not be considered quadriceps sparing.