There is no need to struggle with approaches to the knee
One skin cut down the middle is all there needs to be.
For this goes down the watershed where venous blood divides
Medially and laterally to drain to both the sides.
What’s more you see the arteries all come from behind
Where the popliteal vessels are positioned, you will find.
From there the feeding arteries flow forward to supply
The brisk anastomoses round the knee and distal thigh.
No need to use a tourniquet with this approach, you know
Your skin cut follows faithfully the region of least flow.
You’ll find there’s not much bleeding when you cut the skin right there
Where capillaries are numerous, but arteries are rare.
Now expose the deeper tissues with the utmost care
To show the detailed structure of extensor tendons here.
You preserve the vastus muscles (most important as you know)
For you split their common tendon down the middle as you go.
Now it becomes quite plain that you can go down either side
Of the patellar tendon, however you decide.
Medially or laterally, you now make your incision
To veer in the direction of your surgical decision.
With the diathermy, now the retinaculum dissect
Off the bone of the patella and then you can reflect
The retinaculum and capsule, all intact, towards one side.
Now with the knee in full extension dislocate the other side.
To retain the dislocation, and flex the knee, it’s neat
To use Smillie's retractor, your surgery to complete.
The exposure is delightful and the blood loss is so small
That you seldom need transfusion of any blood at all.
So, with the lateral compartment you use the same incision
Through the skin and through the facia and quadriceps division.
The only real difference appears when you divide
The patellar retinaculum towards the lateral side.
Now, when you come to insert the lateral “Uni knee”
Your exposure will be perfect for “Strover’s cut” you’ll see.
Now the cut across the tibia, oblique fifteen degrees,
With patellar dislocation is made with utmost ease.
And then the great finale of this approach is thus:
You dislocate patella with very little fuss.
And finally at closure, the retinaculum restore
To the dorsum of the kneecap, where it was before.
In conclusion, therefore, there’s no need to minimise
The entry to the knee joint and thus to compromise
The anatomical integrity of structures there inside
KEEP IT SIMPLE STUPID and make your entry wide.
Dr (Mr) Angus Strover
Mr Strover is now retired but until 2012 was consulting at London Sports Orthopaedics at London Bridge Hospital, London, and was a founder of the Droitwich Knee Clinic (in Worcestershire, UK). He is President of the educational charity, The Knee Foundation, which runs both a fellowship training...read more