The incision may go either through or around the patellar tendon. It is important that it be made directly in line with the medullary canal. This may only be possible by going through the tendon (a), but if the tendon can be retracted sufficiently for direct access, this is also possible (b).
Proximal tibial shaft fractures tend to develop a valgus deformity if the nail entry site is placed too medially. A more laterally placed skin incision may be needed to avoid this problem.
Studies have found no difference in knee pain between an incision through or beside the patellar tendon.