Medial Approach to Knee Joint

  • The medial approach to knee joint provides a good exposure of the ligamentous structures on the medial side of the knee.

  • Medial Approach to Knee Joint uses include:
    1. Repair of medial knee ligaments.
    2. Medial meniscus tear repair or meniscectomy.
    3. Anterior cruciate ligament injury repair.

  •  Place the patient supine with knee flexed 60°, hip abducted and externally rotated.

  • Landmark:
    • Adductor tubercle along medial aspect of knee.
    • Make long, curved incision 2 cm proximal to the adductor tubercle
    • start midline and end 6 cm below the joint line with slight anterior curve.

  • There is no true internervous plane in the medial approach to knee joint.

  • Raise skin flaps exposing fascia:
    • extend to midline anteriorly and to posteromedial corner posteriorly.
  • Sacrifice the infrapatellar branch of the saphenous nerve:
    • crosses the field transversely.
  • Preserve the saphenous nerve itself:
    • emerges between sartorius and gracilis muscles.

  • Can either be exposed anterior or posterior to superficial medial collateral ligament:
    • Anterior to the superficial medial collateral ligament:
      • provides access to anteromedial side of joint (superficial medial ligament, anterior aspect of medial meniscus, cruciate ligament).
      • incise the fascia along the anterior border of sartorius.
      • flex the knee to allow sartorius to retract posteriorly.
        • knee flexion uncovers the semitendinosis and gracilis.
      • retract all three pes muscles posteriorly to expose the tibial insertion of the superficial medial ligament.
      • make a longitudinal medial parapatellar incision to access joint.
    • Posterior to the superficial medial collateral ligament:
      • provides access to posteromedial side of joint (posterior aspect of the medial meniscus, posteromedial corner).
      • incise the fascia along the anterior border of sartorius muscle.
      • retract the sartorius posteriorly, together with semitendinosis and gracilis muscles.
      • if the capsule is intact, expose the posteromedial corner of the joint by separating the medial head of gastrocnemius from semimembranosus muscle.
      • separate the medial head of gastrocnemius muscle from the posterior capsule.

  • The medial approach to knee joint cannot be extended usefully in either direction .

  • The structures at risk during medial approach to knee joint include:

    1. Infrapatellar branch of the saphenous nerve:
      • crosses transversely across operative field.
      • usually sacrificed.
      • should be buried in fat to prevent neuroma.
    2. Saphenous vein:
      • located between sartorius and gracilis.
    3. Medial inferior genicular artery:
      • may be damaged as medial head of gastrocnemius is lifted off tibia.
    4. Popliteal artery:
      • lies along midline posterior joint capsule.
      • adjacent to medial head of gastrocnemius.

  • Surgical Exposures in Orthopaedics book - 4th Edition
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Images Source:
  • Surgical Exposures in Orthopaedics 4th Edition Book.

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