Open Approach for Bony Avulsion Surgical Technique

 

PCL Avulsion 2PCL Avulsion 1

 

Open approach

 

A. Posterior approach to Knee

 

S shaped incision

- lateral proximally to medial distally

 

Superficial dissection

- small saphenous vein and medial sural nerve identified midline distally

- open deep fascia

 

Deep dissection

- popliteal fossa

- superiorly: semimebranosus & semitendinosus medial, biceps femoris lateral

- inferiorly: medial and lateral gastrocnemius

- popliteal artery deep and medial

- vein in middle, tibial nerve lateral

- common peroneal nerve laterally with biceps 

 

Find and protect medial sural nerve

- track to tibial nerve

 

Identify and ligate middle genicular artery

- allows mobilisation of vessel

- retract neurovascular structures laterally

 

Open capsule

 

B.  Burk modified posterior approach / Posteromedial approach

 

Advantages

- avoids major neurovascular bundle

 

Interval between semimembranosus and medial gastrocnemius

- semimembranosus medially

- medial head gastrocnemius laterally / can be released

- release popliteus from medial tibia and reflect laterally

- place blunt homan across tibia

- open capsule

 

Posteromedial approach knee 1Posteromedial approach knee 2Posteromedial approach knee 3

 

AO foundation surgical approach

 

Vumedi video

 

Fixation options

- size dependent

- screw / staple

 

PCL bony fixationPCL bony fixation 2