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