Introduction Indications exposure for lateral knee ligament repair or reconstruction open lateral meniscal repair Anatomy There are three anatomic layers to the lateral knee layer 1 ITB biceps fascia layer 2 patellar retinaculum patellofemoral ligament layer 3 LCL arcuate ligament fabellofibular ligament capsule Internervous plane Internervous between iliotibial band (ITB) (superior gluteal nerve) anteriorly biceps femoris tendon (sciatic nerve) posteriorly Approach Incision landmarks palpate lateral border of patella over lateral joint palpate Gerdy's tubercle marking insertion of IT band knee should be flexed during approach make long, curved incision at lateral border of center of patella begin 3 cm lateral to edge of patella end 4-5 cm distal to joint centered over Gerdy's tubercle Superficial dissection mobilize skin flaps widely incise fascia between ITB and biceps femoris avoid common peroneal nerve on posterior border of biceps femoris retract ITB anteriorly and biceps posteriorly exposes superficial lateral collateral ligament (LCL) retract lateral head of gastrocnemius posteriorly Deep dissection can enter knee joint anterior or posterior to LCL anterior arthrotomy exposes entire lateral meniscus posterior arthrotomy exposes posterior horn of lateral meniscus and posterolateral corne Dangers Common peroneal nerve at risk on posterior border of biceps femoris Popliteal artery at risk posterior to posterior horn of lateral meniscus Popliteus tendon runs within joint adjacent to lateral meniscus attaches to posterior aspect of meniscus and femur at risk if performing a posterior arthrotomy Lateral superior genicular artery at risk between femur and vastus lateralis Lateral inferior genicular artery at risk between lateral head of gastrocnemius and posterolateral corner should be ligated