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Knee

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With the patient supine and the affected knee flexed about 60 degrees, place the foot on the opposite shin and abduct and externally rotate the hip. Begin the incision 2 cm proximal to the adductor tubercle of the femur, curve it anteroinferiorly about 3 cm medial to the medial border of the patella, and end it 6 cm distal to the joint line on the anteromedial aspect of the tibia. Then retract the skin flaps to expose the fascia of the knee. Extend the exposure from the midline anteriorly to the posteromedial corner of the knee. Cut the infrapatellar branch of the saphenous nerve and bury its end in fat; preserve the saphenous nerve itself and the long saphenous vein. Longitudinally incise the fascia along the anterior border of the sartorius, starting at the tibial attachment of the muscle and extending it to 5 cm proximal to the joint line. Flex the knee further and allow the sartorius to retract posteriorly, thus exposing the semitendinosus and gracilis muscles Next, retract all three components of the pes anserinus posteriorly and expose the tibial attachment of the tibial collateral ligament, which inserts 6 to 7 cm distal to the joint line. To open the joint anteriorly, make a longitudinal medial parapatellar incision through the retinaculum and synovium.
To expose the posterior third of the medial meniscus and the posteromedial corner of the knee, retract the three components of the pes anserinus posteriorly and separate the medial head of the gastrocnemius from the posterior capsule of the knee, almost to the midline by blunt dissection. To open the joint posteriorly, make an incision through the capsule posterior to the tibial collateral ligament.



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