Once the incision is made, the quadriceps tendon, the patella and the patellar tendon are identified. A medial para-patellar arthrotomy is made and the soft tissues are elevated from the tibia. Great care must be taken not to strip to much medially or laterally as this may result in disruption of the medial collateral ligament or the patellar tendon, respectfully. Both are disastrous complications.
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The patella and patellar tendon are released from the underlying fat pad and other soft tissues so the patella may be everted laterally to expose the distal femur and proximal tibia.
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