Positioning and incision planning. Positioning the limb at 90° flexion will facilitate the exposure. The medial-sub vastus approach is performed, which aids later graft passage, allows access to the joint if arthrotomy is required, and facilitates a TTO if necessary. Skin incision will require utilizations of scars, however, it should be kept in mind the deeper dissection lies medial – depicted here by the blue dotted line.