Many methods of surgical exposure allow successful total knee arthroplasty (TKA). Regardless of the method used, exposure that is sufficient to allow consistently successful total knee implant placement and alignment should be a primary concern. A standard anterior midline skin incision with a medial parapatellar arthrotomy continues to be the most widely used method of exposure for TKA.10 The extensor mechanism of the knee—composed of the quadriceps muscle and tendon, patella, and patellar tendon—comprises biomechanically and anatomically complex, interacting structures that work together to provide effective knee function. Proper preservation of the extensor mechanism is vital to successful recovery following TKA. The main advantage of the anterior approach to the knee is that it provides excellent visualization and access to the distal femur, proximal tibia, and patella. Although not extensile in the classic sense, it is more extensile than most TKA approaches.