Medial Approach to the Knee

Position

  • supine
  • foot rest
  • lateral support
  • knee in figure of 4 position

Landmarks

  • adductor tubercle
    • medial surface of MFC posteriorly

Incision

  • curved longitudinal incision
  • Start: 2cm proximal to adductor tubercle of femur
  • Curved anteroinferiorly to a point
  • End: 6cm below the joint line on the anteromedial aspect of tibia

Superficial Dissection

  • Raise skin flaps to expose fascia
    • infrapatellar brnahc of the saphenous nerve crosses transversely & is sacrificed
    • Being careful to preserve the long saphenous vein

Deep Dissection

  • Can go Anterior or Posterior to MCL
  • Identify anterior border of sartorius & incise the fascia starting distally at it’s insertion & working proximally
  • Retract Pes Anserinus posteriorly to expose the superficial medial collateral ligament
  • Flexing the knee further facilitates this
  • Anteriorly
    • Longitudinal medial parapatellar incision to gain access to the joint
  • Posteriorly
    • Separate medial head of gastrocnemius & semimembranosus

Dangers

  • Nerves
    • Infrapatella branch of saphenous nerve
  • Vessels
    • Saphenous vein
    • Medial inferior genicular artery
    • Popliteal artery