Anteromedial approach to distal two thirds of femur

Position

  • supine
  • prep & drape leg free

Landmarks

  • Vastus medialis
  • Medial joint line
  • Medial epicondyle
  • Patella

Incision

  • 15 cm longitudinal incision centred over anteromedial aspect of thigh over interval between rectus & vastus medialis
  • extend incision medial to patella

Internervous Plane

  • Vastus medialis
    • Femoral nerve
  • Rectus femoris
    • Femoral nerve

Superficial Dissection

  • Subcutaneous fat
  • Incise the deep fascia in line with skin incision
  • Identify & develop the plane between vastus medialis & rectus femoris
    • Cutting along the edge of quadriceps tendon
    • Leaving a cuff for later repair

Deep Dissection

  • Extend my incision proximally & distally exposing the anterior aspect of distal femur
  • Proximally
    • Split vastus intermedius in line with its fibres

Dangers

  • Vessels
    • Medial superior geniculate artery