Supine positioning, with a nonsterile leg holder to help maintain knee flexion and a nonsterile post to prevent passive hip abduction during the operation (Figure 45.1).

Midline incision, starting approximately 6 cm proximal to the superior pole of the patella and ending just medial to the tibial tubercle.

Care should be taken to allow adequate closure of the medial capsule—avoid going into vastus medialis obliquus, leave a small cuff of tissue on medial patella, and avoid overrelease medially off the plateau at the distal aspect of the arthrotomy.

Closure should provide robust support of the capsule at the medial edge of the patella as this area sees the highest stress when flexing the knee postoperatively.

Sandbag or other leg positioner to attach to the table under the drapes

Post to attach to the table proximally to prevent hip abduction

One bent Hohmann retractor

One Chandler blunt retractor

Two curved cobra retractors

One posterior knee retractor

Ioban or similar adhesive barrier dressing

Preoperatively the limb is examined for prior incisions, contractures, and deformity.

If multiple incisions are present, the lateral-most incision that will allow safe exposure for medial parapatellar approach is selected.

A good neurovascular examination should be performed and documented before any knee operation.