Step 4 The Posteromedial Incision

The next step is to create a posteromedial or posterolateral incision (Fig. 6.13). On the medial side, with the knee at 90° of flexion, this technique is a 3 to 6 cm incision placed just posterior to the medial collateral lig ament extending distally from the joint line. As the trajectory of the zone-specific needles will always be in a craniocaudal direction, there is little indication to extend this incision superiorly above the joint line. The presartorial fascia is then incised sufficiently to allow posterior retraction of the pes anserinus; the saphenous nerve may be retracted posteriorly. Blunt dissection is then used to come down upon the joint capsule and the medial gastrocnemius posteriorly and the semimem-branosus anteriorly. A retractor is then placed posterior to the medial head of the gastrocnemius. The retractor is necessary to protect the assistant from needle stick injury and to protect the saphenous nerve.

Figure 6.12. The rasp for preparing the meniscal tear and the cannulas for inserting the needles.

Figure 6.13. The posterior medial incision.

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