OrthoNet

Knee - posterior approach

* position - supine & tourniquet

* incision
- start lat. over BF & bring incision obliquely across popliteal fossa
- turn down over med. head of gastroc.

* no internervous plane

* dissection
- reflect skin flaps
- expose lesser saphenous v.
- running lat. to vein is med. sural n. (branch of tibial n.)
- incise fascia of popliteal fossa just med. to lesser saphenous v.
- trace med. sural n. back to tibial n.
- dissect up to apex of popliteal fossa following tibial n.
- at apex, CPN separates from tibial n.
- ID popliteal art. & vein
- art. has 5 branches — 2 superior, 2 inferior & 1 middle genicular art.
- vein lies med. to art. as it enters popliteal fossa from below
- curves lying directly post. while in fossa
- moves to posterolat. side of art. above knee joint

> posteromed. joint capsule
- detach origin of med. head of gastroc. from back of femur
- retract head lat. & inf.
- expose posteromed. joint

> posterolat. corner
- detach origin of lat. head of gastroc. from lat. fem. condyle
- develop interval btw gastroc. & BF
- incise joint capsule

* dangers
- med. sural n. - lies lat. to lesser saphenous v. so incise fascia med. to vein
- tibial n.
- CPN
- popliteal vessels