Anterolateral Approach to Tibia

Anterolateral approach to the proximal tibia, showing the curved skin incision below the knee and the exposure of the lateral tibial metaphy
Anterolateral approach to the proximal tibia, showing the curved skin incision below the knee and the exposure of the lateral tibial metaphysis. Image from Kumar Yadav S, Prakash V, Kumar Rajnish R, Kantiwal P, Elhence A. An Innovative Reconstruction Technique for Proximal Tibia Grade 3 Giant Cell Tumor, The Sky Roof Reconstruction Approach. Cureus. 2025, 17(8), e89520. CC BY 4.0.
Anterolateral Approach to Tibia, anterior compartment of the leg showing tibialis anterior
Anterior compartment of the leg showing tibialis anterior. Image by Polygon data were generated by Database Center for Life Science (DBCLS)[2], Wikimedia Commons, CC BY-SA 2.1 jp.

Indications

  • middle 2/3 of tibia when anterior approach not suitable due to skin

Position

  • Lateral
  • Pad bony prominences

Landmarks

  • Subcutaneous surface of fibula
  • Fibula head
  • Tibial shaft

Incision

  • Straight longitudinal incision
  • Over the shaft of the fibula

Internervous Plane

Superficial Dissection

  • deepen the incision
  • taking care not to damage the
    • short saphenous vein in the posterior aspect of the wound
  • incise fascia
  • identify the underlying peroneal muscles
  • develop a plane between peroneus brevis & EDL
  • taking care not to damage the
    • superficial peroneal nerve

Deep Dissection

  • gently detach the extensor musculature from the anterior aspect of the interosseous membrane
  • follow the anterior aspect of the membrane onto the lateral border of the tibia

Dangers

  • Nerves
    • Superficial peroneal nerve
  • Vessels
    • Small saphenous vein

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