AANA Middle East Arthroscopy Master Course (International)-Deep Dive _Key Pearls Dissection Anatomy of the Knee

Deep Dive _Key Pearls Dissection Anatomy of the Knee

Pdf Summary

This presentation by Dr. Mark R. Hutchinson focuses on the detailed anatomy of the knee critical for surgical dissection and repair. Emphasizing anatomy as the foundation of successful knee procedures, it underscores the importance of understanding neurovascular structures, bony and soft tissue landmarks, ligament insertions, and meniscal attachments to avoid iatrogenic damage.

Key points include:

1. <strong>Superficial Anterior Approach</strong>: Begin with an extensile anterior medial incision to expose skin, fascia, and medial to posterior medial knee structures. Assess the extensor mechanism, vastus medialis obliquus (VMO), and patellar tracking. Important landmarks include the medial patellofemoral ligament (MPFL)—a static stabilizer guiding the patella during early flexion and commonly torn in patellar dislocations—and its proximity to other ligament insertions.

2. <strong>Medial Collateral Ligament (MCL) Complex</strong>: The pes anserinus tendons insert 4-5 cm below the joint line on the anterior medial knee. The superficial MCL lies deep beneath these tendons (posing healing challenges) and attaches 6 cm below the joint line; deep MCL fibers connect intimately with the meniscus (meniscofemoral and meniscotibial ligaments). Dysfunction here may contribute to meniscal instability.

3. <strong>Posterolateral Corner</strong>: Identification of the iliotibial (IT) band, biceps femoris tendon, and the peroneal nerve are essential. Different surgical approaches to deep structures include splitting the IT band, working above or behind the biceps tendon. The lateral collateral ligament (LCL) insertion at the fibular head is accessed via the biceps bursa split. The anterolateral ligament (ALL) should be sought in this region.

4. <strong>Intra-Articular Assessment</strong>: Detaching the patella from the tibial tubercle permits inspection of articular surfaces for iatrogenic injury and verification of tunnel and anchor positioning. Meniscal vascular zones and root anatomy must be carefully evaluated to ensure repair stability and proper healing likelihood.

5. <strong>Posterior Cruciate Ligament (PCL) Anatomy</strong>: Two bundles exist—with the stronger, stiffer anterolateral bundle tight in flexion (max load ~1120 N), and the posterior-medial bundle, weaker and tight in extension (max load ~419 N). Knowledge of these is vital during posterior knee dissections.

The presentation also stresses continually assessing repair quality, proper tunnel placement, and avoiding nerve injury throughout dissection. A complementary dissection video by LaPrade further illustrates these concepts. In sum, a meticulous, anatomy-driven approach is fundamental for optimizing surgical outcomes in knee procedures.

Keywords

knee anatomy

surgical dissection

knee repair

superficial anterior approach

medial collateral ligament

posterolateral corner

intra-articular assessment

posterior cruciate ligament

meniscal attachments

neurovascular structures