MIS TKA with a Subvastus Approach



Performing minimally invasive (MIS) total knee arthroplasty (TKA) through a subvastus approach makes sense on an anatomic basis, on a scientific basis, and on a practical basis. Anatomically, the subvastus approach is the only approach that saves the entire quadriceps tendon insertion on the patella1–5 (Fig. 32.1). Scientifically, the subvastus approach has been shown, in prospective randomized clinical trials, to be superior to the standard medial parapatellar arthrotomy and to the so-called quadriceps-sparing arthrotomy3,6,7 (Table 32.1). Practically, MIS TKA with a subvastus approach is reliable, reproducible, and efficient and allows the MIS technique to be applied to a broad group of patients, not just a highly selected subgroup8 (Table 32.2).


Total Knee Arthroplasty Prospective Randomized Clinical Trial Medial Patellofemoral Ligament Vastus Medialis Obliquus Cutting Guide 


  1. 1.
    Pagnano MW, Meneghini RM, Trousdale RT. Anatomy of the extensor mechanism in reference to quadriceps-sparing TKA. Clin Orthop Relat Res 2006 Nov, (452):102–105Google Scholar
  2. 2.
    Chang CH, Chen KH, Yang RS, Liu TK. Muscle torques in total knee arthroplasty with subvastus and parapatellar approaches. Clin Orthop Relat Res 2002, 398:189–195CrossRefPubMedGoogle Scholar
  3. 3.
    Faure BT, Benjamin JB, Lindsey B, Volz RG, Schutte D. Comparison of the subvastus and paramedian surgical approaches in bilateral knee arthroplasty. J Arthroplasty 1993, 8(5):511–516CrossRefPubMedGoogle Scholar
  4. 4.
    Gore DR, Sellinger DS, Gassner KJ, Glaeser ST. Subvastus approach for total knee arthroplasty. Orthopedics 2003, 26:33–35PubMedGoogle Scholar
  5. 5.
    Hoffman AA, Plaster RL, Murdock LE. Subvastus (southern) approach for primary total knee arthroplasty. Clin Orthop Relat Res 1991, 269:70–77Google Scholar
  6. 6.
    Aglietti P, Baldini A. A prospective, randomized study of the mini subvastus versus quad-sparing approaches for TKA. Presented at the Interim Meeting of the Knee Society. September 8, 2005, New York, NYGoogle Scholar
  7. 7.
    Roysam GS, Oakley MJ. Subvastus approach for total knee arthroplasty: a prospective, randomized, and observer-blinded trial. J Arthroplasty 2001, 16:454–457CrossRefPubMedGoogle Scholar
  8. 8.
    Pagnano MW, Leone JM, Hanssen AD, Lewallen DG. Minimally invasive total knee arthroplasty with an optimized subvastus approach: a consecutive series of 103 patients. Presented at American Academy of Orthopaedic Surgeons Annual Meeting. 2005, Washington DCGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryMayo Clinic College of Medicine, Mayo ClinicRochesterUSA

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