OPERATIVE TECHNIQUE
A radiolucent table is required and the patient is positioned supine with a bump or
beanbag beneath the ipsilateral buttock in order to ensure that the patella is facing anteriorly. A non-sterile tourniquet is applied to the proximal thigh prior to sterile prepping and draping, although we routinely do not inflate the tourniquet unless visualization is impaired by excessive bleeding. Alternatively, a sterile tourniquet can be used at the surgeon’s discretion or if additional procedures are planned. A bump is placed under the knee to keep 20-30 degrees of flexion throughout exposure. A longitudinal skin incision extending from 5cm proximal to the superior pole of the patella to the tibial tubercle is made. This incision may be centered over the lateral border of the patella or midline based on surgeon preference, however, we advocate for the use of a laterally based incision to minimize soft tissue disruption over the planned arthrotomy site and to distance the incision from the underlying implants. The extensor mechanism is identified and soft tissue flaps are created to permit visualization and assessment of both the medial and lateral retinaculum.