The minimally invasive surgery subvastus approach provides very good exposure through a small incision, preserves all 4 attachments of the quadriceps to the patella, does not require patella eversion, minimizes disruption in the suprapatellar pouch, and allows rapid and reliable closure of the knee. The patella and entire distal portion of the extensor mechanism can be retracted into the lateral gutter of the knee where they remain out of the way and allow direct visualization of both femoral condyles. When coupled with instruments designed specifically for small incision surgery, the modified subvastus approach is reliable, reproducible, and safe. Using a simple set of retractors the surgeon can perform the surgery without making any blind cuts or freehand cuts and that enhances surgical accuracy and patient safety.