Lateral Approach to Knee Joint
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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:
- Exposure for lateral knee ligament repair or reconstruction.
- 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.
- Make long, curved incision at the lateral border of center of patella.
- Internervous in Lateral Approach to Knee Joint lies between:
- Iliotibial band (ITB): it’s innervated by the superior gluteal nerve.
- 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.
- Anterior arthrotomy:
- Lateral approach to knee joint cannot be extended usefully.
- The structures at risk during Lateral Approach to Knee Joint includes:
- Common peroneal nerve:
- at risk on posterior border of biceps femoris.
- Popliteal artery:
- at risk posterior to posterior horn of lateral meniscus.
- Popliteus tendon:
- runs within joint adjacent to lateral meniscus.
- attaches to posterior aspect of meniscus and femur.
- at risk if performing a posterior arthrotomy.
- Lateral superior genicular artery:
- at risk between femur and vastus lateralis.
- Lateral inferior genicular artery:
- at risk between lateral head of gastrocnemius and posterolateral corner.
- should be ligated.
- Common peroneal nerve:
- Surgical Exposures in Orthopaedics book - 4th Edition
- Campbel's Operative Orthopaedics book 12th
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