Fernandez extensile anterior approach. A, Anterolateral incision. B, Extensor mechanism exposed. C, Iliotibial band is reflected with Gerdy’s tubercle. Anterior compartment and pes anserinus are detached and elevated as necessary. Osteotomy of tibial tuberosity is outlined, and screw holes are predrilled (see text). D, Patella, patellar tendon, and tibial tuberosity are elevated. E, Medial and lateral menisci are detached anteriorly and peripherally and are elevated. F, Meniscal repair is performed with 2-0 nonabsorbable sutures (see text). Gerdy’s tubercle is reattached with lag screw. Anterior tibial and pes anserinus are reattached. G, Tibial tuberosity is secured with lag screws engaging posterior cortex of tibia. Capsule is closed with interrupted sutures. Sutures in periphery of menisci are now tied (see text). (Modified from Fernandez DL: Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures, J Bone Joint Surg 70A:208, 1988.) SEE TECHNIQUE 1.53.