This document describes the posteromedial and posterolateral approaches to the knee. The posterolateral approach, also called the Henderson approach, involves an incision along the lateral side of the knee to access the posterolateral compartment. The direct posterolateral approach uses the interval between the popliteus and soleus muscles to expose the upper lateral tibia. The posteromedial approach, also a Henderson approach, involves an incision along the medial side through the semimembranosus and semitendinosus muscles to access the posteromedial compartment. A direct posteromedial approach uses the interval between the semimembranosus complex and medial head of gastrocnemius muscle. Both approaches aim to provide

1. POSTEROMEDIAL AND
POSTEROLATERAL APPROACH TO KNEE
PRESENTED BY:-Dr. Bipul Borthakur
Professor , Dept of Orthopaedics
Silchar medical college and hospital

2. INTRODUCTION
• In some patients, a median septum separates
the posterior aspect of the knee into two
compartments.
• The presence of this septum may assume
great importance when exploring the
posterior aspect of the knee.

3. POSTEROLATERAL APPROACH
HENDERSON APPROACH
INDICATIONS
• Drainage of posterior compartment
• Loose bodies
POSITION
• Patient is kept in supine position
• Tourniquet is applied at the level of thigh
Knee is flexed between 60 and 90degrees
INCISION
• A curved incision on the lateral
side of the knee just anterior to the biceps
femoris and head of fibula is made

4. • Trace the anterior surface of the intermuscular
septum to the linea aspera 5cm proximal to
the lateral femoral condyle
• The lateral femoral condyle
and the origin of the fibular collateral
ligament is exposed

6. • the popliteus muscle tendon is mobilized and
retracted to expose the posterolateral aspect of the
joint capsule.
• A longitudinal incision is made through
capsule and synovium to access to the
posterior compartment.

8. DANGERS
• Injury to the common peroneal nerve

9. DIRECT POSTEROLATERAL APPROACH
TO THE KNEE
Minkoff et al. described a limited posterolateral
approach to the proximal lateral tibia and knee
Interval between the popliteus andsoleus muscles
is used and exposes the uppermost lateral
portion of the posterior tibial metaphysis and the
proximal tibiofibular joint
Can be used for fractures involving postero
lateral tibial plateau fractures and for conditions
affecting the posterior aspect of the knee

10. The skin incision is made 1 to 2cm below the
popliteal crease slightly medial to the midline
of the knee, carrying it transversely and
curving it distally just medial and parallel to
the head of the fibula, ending 5 to 6cm distal
to it.

11. Incision

12. The skin and subcutaneous flap is reflected
inferomedially.
Lateral cutaneous nerve of the calf is isolated
and retracted it laterally and preserved.

13. Short saphenous vein superficial to the fascia
is identified and is divided and ligated.
Fascia is opened carefully in line with
incision
The sural nerve lies deep to the fascia just
superficial to the heads of the gastrocnemius
muscle and is protected.
The common peroneal nerve is identified and
retracted it laterally

15. Interval between the lateral head of the
gastrocnemius and the soleus muscle is
developed.
Lateral head of the gastrocnemius is
medially reteracted along with the popliteal
artery and vein and the tibial nerve
Fibular origin of the soleus muscle is freed and
retracted it distally

16. Underlying popliteus muscle is medially
retracted to expose the posterior aspect of
the lateral tibial plateau and proximal
tibiofibular joint.

18. POSTEROMEDIAL APPROACH
HENDERSON APPROACH
POSITION
• Patient is kept in supine position
• Tourniquet is applied at the level of thigh
• Knee flexed 90degrees

19. INCISION
• A curved incision appx 7.5cm is made
slightly convex anteriorly
• Distally from the adductor tubercle and along
the course of the tibial collateral
ligament,semimembranosus,semitendinsus,Sa
rtorius and gracilis.

21. The tibial collateral
ligament is exposed and incised
The capsule is longitudinally incidsed
Enter the posteromedial compartment of the knee
posterior to the tibial collateral ligament,retracting
the hamstring tendons posteriorly.

22. DIRECT POSTEROMEDIAL APPROACH
Described by Galla and Lobehoffer
Used for managing medial tibial plateau fractures
Does not involve dissection of the popliteal
neurovascular structures
Uses the interval between the semimembranosus
complex and the medial head of the
Gastrocnemius muscle.

23. A straight 6-to 8-cm-long longitudinal skin incision
is made along the medial border of the medial
head of the gastrocnemius muscle, beginning
at the level of the joint line.
thesubcutaneous tissue and popliteal fascia
is incised sharply
The medial head of the gastrocnemius
muscle is freed without detaching it and
retracted it laterally.

24. Bluntly dissect the semimembranosus complex and
retract it medially
the upper edge of the popliteus muscle is identified and
detached it subperiosteally,exposing the posteromedial
tibial plateau.
If more exposure is needed, incise the tibial
insertion of the semimembranosus muscle in a
subperiosteal
fashion.

26. Chapter 2, Verse 63
krodhaadbhavati sammohah
sammohaatsmritivibhramah |
smritibhramshaadbuddhinaasho
buddhinaashaatpranashyati ||
From anger comes delusion; from delusion, confused
memory; from confused memory the ruin of reason;
from ruin of reason, man finally perishes.
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