Vertical Midtrans-Patellar Arthrotomy Approach for Total Knee Arthroplasty: A Biologically Coherent Full Extensor-Preserving Exposure Strategy
Georges Sioufi, MD, FRCSC1*, Jean-Étienne Beauchamp, MD2, Joseph Najjar, MD3, Michael Zoghby, Ing4, Alexandre Sioufi, BSc, RN, MBA5, Antoine Najjar, Ing6
1Lower Limb Reconstruction - Hip and Knee Arthroplasty, Department of Orthopaedic Surgery, Santa Cabrini Hospital, Montréal, Québec, Canada.
2Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
3Department of Orthopaedic Surgery, University of Balamand, Lebanon.
4Safran, North American Representative.
5Jewish General Hospital, Montréal, Québec, Canada.
6École Supérieure d’Ingénieurs de Beyrouth (ESIB), Saint Joseph University of Beirut (USJ), Beirut, Lebanon.
*Corresponding Author: Georges Sioufi, MD, FRCSC, Lower Limb Reconstruction – Hip and Knee Arthroplasty, Department of Orthopaedic Surgery, Santa Cabrini Hospital, Montréal, Québec, Canada.
https://doi.org/10.58624/SVOAOR.2026.06.025
Received: July 22, 2026
Published: September 17, 2026
Citation: Sioufi G, Beauchamp JE, Najjar J, Zoghby M, Sioufi A, Najjar A. Vertical Midtrans-Patellar Arthrotomy Approach for Total Knee Arthroplasty: A Biologically Coherent Full Extensor-Preserving Exposure Strategy. SVOA Orthopaedics 2026, 6:5, 189-195. doi: 10.58624/SVOAOR.2026.06.025
Abstract
This article describes a vertical midtrans-patellar osteotomy technique for surgical exposure in total knee arthroplasty (TKA). The method represents a bone-based exposure strategy designed to preserve extensor mechanism continuity and micro anatomical integrity while restoring patellar structure through compression bone healing. The osteotomy incorporates a full-length interlocking vertical configuration that preserves medial and lateral stabilizers integrity and allows symmetrical, wide joint exposure. A fundamental principle of the technique is that fixation trajectories are established before initiating the osteotomy, while the patella is still anatomically intact. Predrilled parallel fixation trajectories and the interlocking vertical osteotomy configuration together create a mechanically guided reduction system that restores anatomical patellar articular surface alignment during closure with rigid fixation. By avoiding transection of the medial patellar stabilizers, preserving extensor mechanism continuity, and reconstructing the patella through compression fixation of bone rather than tendon-ligament repair, the technique may facilitate a complete restoration of extensor mechanism integrity, which could theoretically reduce postoperative quadriceps inhibition and promote improved functional recovery. Quadriceps weakness following total knee arthroplasty has been well documented and frequently persists despite adequate postoperative rehabilitation. Cadaveric validation demonstrated an absence of fluid leakage across the osteotomy and tendons fibres spreading interface under progressive saline injection volumes and repeated flexion cycles at varying angles, whereas conventional medial parapatellar arthrotomy specimens demonstrated seepage under similar conditions at the suture sites in the distal pretibial segment of the arthrotomy. An animated surgical video demonstrating the operative steps accompanies this report.
Keywords: knee arthroplasty, surgical approach, Vertical mid-patellar osteotomy, trans-patellar arthrotomy,