| Introduction |
- Indications
- repair of medial knee ligaments
- medial meniscus repair or meniscectomy
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| Anatomy |
- There are three anatomic layers to the medial knee
- layer 1
- sartorius
- deep fascia
- Zone between Layer 1 & 2
- gracilis
- semitendinosus
- layer 2
- superficial MCL
- posterior oblique ligament
- layer 3
- deep MCL
- capsule
- coronary ligaments
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| Intermuscular Plan |
- No internervous or intermuscular plane
|
| Preparation |
- Anesthesia
- general
- sciatic or femoral nerve block
- Position
- Tourniquet
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| Approach |
- Incision
- landmark
- palpate adductor tubercle along medial aspect of knee
- make long, curved incision 2 cm proximal to the adductor tubercle
- start midline
- end 6 cm below the joint line with slight anterior curve
- Superficial dissection
- raise skin flaps exposing fascia
- sacrifice the infrapatellar branch of the saphenous nerve
- nerve crosses field transversely
- save the saphenous nerve itself
- nerve is located between sartorius and gracilis
- Deep dissection
- can either be exposed anterior or posterior to superficial medial collateral ligament
- anterior to the superficial medial collateral ligament
- provides access to anterior medial side of joint
- 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 posterior medial side of joint
- incise the fascia along the anterior border of sartorius
- retract it posteriorly, together with semitendinosis and gracilis
- if the capsule is intact, expose the posteromedial corner of the joint by separating the medial head of gastrocnemius from semimembranosus
- separate the medial head of gastrocnemius from the posterior capsule
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