The meta-analysis identified 18 randomized or quasi-randomized clinical trials (n=1040 patients) comparing the use of the mid vastus (MV) and parapatellar (PP) approaches to total knee arthroplasty (TKA). The primary objective of this study was to determine if differences in functional outcomes arose from the use of these different approaches to TKA. Pooling of results suggested that the use of an MV approach reduced immediate postoperative pain and increased range of motion during the first week. In addition, the MV approach also reduced the number of lateral releases required, without increasing the risk of complications or impairment of the quadriceps function.