Lateral Approach to Knee Joint

  • The lateral approach to knee joint provides access to all the supporting structures on the lateral side of the knee.

  • Lateral Approach to Knee Joint can be used for:
    1. Exposure for lateral knee ligament repair or reconstruction.
    2. Open lateral meniscal tear repair.

  • Place the patient supine on the operating table.
    • with a sandbag under the buttock of the affected side.
    • Knee should be flexed during approach

  • Landmarks:
    • Lateral border of patella.
    • Gerdy’s tubercle.
      • Marking insertion of ilio-tibial band.
  • Incesion:
    • Make long, curved incision at the lateral border of center of patella.
      • begin 3 cm lateral to edge of patella,
      • end 4-5 cm distal to joint centered over Gerdy’s tubercle.

  • Internervous in Lateral Approach to Knee Joint  lies between:
    1. Iliotibial band (ITB):  it’s innervated by the superior gluteal nerve.
    2. Biceps femoris tendon: it’s innervated sciatic nerve.

  • Obilize skin flaps widely.
  • Incise fascia between Iliotibial band (ITB) anteriorly and biceps femoris tendon posteriorly:
    • avoid common peroneal nerve on posterior border of biceps femoris tendon.
    • retract ITB anteriorly and biceps tendon posteriorly:
      • exposes superficial lateral collateral ligament (LCL).
  • Retract lateral head of gastrocnemius posteriorly.

  • Knee joint can be exposed anterior or posterior to lateral collateral ligament (LCL):
    • Anterior arthrotomy:
      • exposes entire lateral meniscus.
    • Posterior arthrotomy:
      • exposes posterior horn of lateral meniscus and posterolateral corner.

  • Lateral approach to knee joint cannot be extended usefully.

  • The structures at risk during Lateral Approach to Knee Joint  includes:
    1. Common peroneal nerve:
      • at risk on posterior border of biceps femoris.
    2. Popliteal artery:
      • at risk posterior to posterior horn of lateral meniscus.
    3. Popliteus tendon:
      • runs within joint adjacent to lateral meniscus.
      • attaches to posterior aspect of meniscus and femur.
      • at risk if performing a posterior arthrotomy.
    4. Lateral superior genicular artery:
      •  at risk between femur and vastus lateralis.
    5. Lateral inferior genicular artery:
      • at risk between lateral head of gastrocnemius and posterolateral corner.
      • should be ligated.

  • Surgical Exposures in Orthopaedics book - 4th Edition
  • Campbel's Operative Orthopaedics book 12th
Lateral Approach to Knee Joint Lateral Approach to Knee Joint Lateral Approach to Knee Joint Lateral Approach to Knee Joint knee Lateral Approach
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