Thirty two randomized controlled trials with a total of 2129 patients (2451 knees) were included in this meta-analysis. The purpose was to compare subvastus and midvastus approaches with the medial parapatellar approach in total knee arthroplasty (TKA) to determine whether there was a difference in efficacy and safety. The study determined that the midvastus approach was associated with more favourable outcomes in pain and knee range of motion, but also with a longer operation time. The subvastus approach was affiliated with more favorable outcomes in straight leg raise, lateral retinacular release, and knee range of motion 1 week after surgery. These early benefits unfortunately did not persist in the longer term.