MIS Total Knee Arthroplasty Muscle-Sparing Arthrotomy

Successful total knee arthroplasty depends in part on reestablishment of normal lower extremity alignment, proper implant design and orientation, secure implant fixation, and adequate soft-tissue balancing and stability.

The operative technique for the standard total knee arthroplasty (TKA) involves a skin incision between 16 cm (6 in) and 30 cm (12 in). In comparison, when Dr. Luke Vaughan started talking about a "shorter incision" in 2000 for primary total knee arthroplasty, he suggested that 10 cm (4 in) was a good starting point and the incision could be extended if needed. Since that time, some surgeons are reporting that a skin incision for the MIS Quad-Sparing technique may be as short as 8 cm (3 in).

Total knee arthroplasty using a less invasive technique is suggested for non-obese patients with preoperative flexion greater than 90 degrees. Patients with varus deformities greater than 17 degrees or valgus deformities greater than 13 degrees are typically not candidates for a smaller incision technique.

The goal of less invasive knee surgery is to limit the muscle and tissue dissection without compromising the procedure. Minimally invasive TKA can be accomplished through a modified version of one of the standard TKA exposures — subvastus, midvastus, or medial parapatellar — or through an MIS Quad-Sparing arthrotomy. The arthrotomy chosen will depend on surgeon preference, experience, and training. 

MIS Midvastus Arthrotomy

MIS Medial Parapatellar Arthrotomy

The medial parapatellar total knee arthrotomy is the most common approach to standard total knee arthroplasty. The MIS medial parapatellar arthrotomy is a modification of the traditional approach and provides excellent exposure of all 3 knee compartments. The arthrotomy extends approximately 2 cm into the quadriceps tendon. The arthrotomy can be extended easily if more visualization is needed.

MIS Quad-Sparing Arthrotomy

The MIS Quad-Sparing approach to the knee joint is an innovative approach initially pioneered by Dr. Thomas M. Coon, Dr. E. Marlowe Goble, and Dr. Alfred J. Tria, Jr. There is no incision into muscle or tendon. The muscle is not moved or disrupted. The suprapatellar pouch is protected. Zimmer Institute training is available for surgeons interested in learning the MIS Quad-Sparing approach to TKA.

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