Medial Approach to the Knee

Medial knee landmarks, with the medial femoral epicondyle (circle), the joint line (dotted line) and the pes anserinus insertion (parallel l
Medial knee landmarks, with the medial femoral epicondyle (circle), the joint line (dotted line) and the pes anserinus insertion (parallel lines), and the incision running between epicondyle and pes anserinus. Image from Borque KA, Ball S, Sij E, Amis AA, Laughlin MS, Jones M, Williams A. A "Short Isometric Construct" Reconstruction Technique for the Medial Collateral Ligament of the Knee. Arthrosc Tech. 2023, 12(2), e167-e171. CC BY 4.0.
Diagram of the medial side of the flexed knee
Medial view of a flexed knee, showing the medial patellofemoral ligament and nearby structures. Image by Roberto Negrin, Nicholas Reyes, Magaly Iniguez, Nicolas Gaggero, Wikimedia Commons, CC BY 4.0.

Position

  • supine
  • foot rest
  • lateral support
  • knee in figure of 4 position

Landmarks

  • adductor tubercle
    • medial surface of MFC posteriorly

Incision

  • curved longitudinal incision
  • Start: 2cm proximal to adductor tubercle of femur
  • Curved anteroinferiorly to a point
  • End: 6cm below the joint line on the anteromedial aspect of tibia

Superficial Dissection

  • Raise skin flaps to expose fascia
    • infrapatellar branch of the saphenous nerve crosses transversely & is sacrificed
    • Being careful to preserve the long saphenous vein

Deep Dissection

  • Can go Anterior or Posterior to MCL
  • Identify anterior border of sartorius & incise the fascia starting distally at its insertion & working proximally
  • Retract Pes Anserinus posteriorly to expose the superficial medial collateral ligament
  • Flexing the knee further facilitates this
  • Anteriorly
    • Longitudinal medial parapatellar incision to gain access to the joint
  • Posteriorly
    • Separate medial head of gastrocnemius & semimembranosus

Dangers

  • Nerves
    • Infrapatella branch of saphenous nerve
  • Vessels
    • Saphenous vein
    • Medial inferior genicular artery
    • Popliteal artery

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.