The direct posterior approach to the knee: surgical and anatomic approach

The direct posterior surgical approach to the knee provides broad exposure of posterior neurovascular structures, the posterior aspect of the femoral condyles and tibial plateau, the posterior joint capsule, and a variety of additional soft-tissue structures including the popliteus, hamstring insertions, and origins of the gastrocnemius. Reported indications for this approach include tumor resection, posterior synovectomy, open reduction and internal fixation of posterior tibial plateau shear fractures, fixation of bone avulsions associated with a posterior cruciate ligament (PCL) injury, repair of posterior vascular injuries, and more recently, posterior inlay PCL reconstructions. However, use of this approach is uncommon and as a result, orthopedic residents and practicing orthopedic surgeons may not be familiar with the appropriate surgical anatomy. This report demonstrates in stepwise fashion the surgical approach and relevant anatomy through a detailed series of fresh cadaveric dissections.