Transverse incision advantages for total knee arthroplasty

The Surgical Anatomy of the Infrapatellar Branch of the Saphenous Nerve in Relation to Incisions for Anteromedial Knee Surgery

“…In accordance with the literature, we hypothesized that horizontal incisions lead to less iatrogenic damage and fewer subsequent postoperative complications than do longitudinal incisions 1,6,18,20,29,40 . Two recent studies have investigated the possibility of transverse or horizontal incisions for various surgical procedures on the anteromedial aspect of the knee 18,41 .…”

“…Similarly, low risk zones 2 and 3 provide for a safer approach in tibial nailing and retrograde nailing of the femur. In total knee arthroplasty, when the medial edges of low risk zones 2 and 3 are taken into account, the transverse approach described by Ojima et al 18 may be even more beneficial regarding complications related to the infrapatellar branch of the saphenous nerve. Furthermore, when the location-dependent direction of the infrapatellar branch of the saphenous nerve is taken into account, a cranial deviation of the lateral and medial part of the incision, resulting in a horizontal ''smile'' incision just distal to the patella, might further reduce iatrogenic damage to the nerve as the incision then mostly runs perpendicular to the infrapatellar nerve ( Fig.…”

“…A disadvantage of nonlongitudinal incisions in routine surgery on the anteromedial part of the knee is that subsequent total or partial knee replacement is mostly performed using a longitudinal incision, and the patient would have two perpendicular and crossing incisions. However, Ojima et al showed that total knee arthroplasty using a transverse incision is technically feasible 18 . Conversely, horizontal incisions cannot be extended and are limited in both length and direction.…”

“…Two recent studies have investigated the possibility of transverse or horizontal incisions for various surgical procedures on the anteromedial aspect of the knee 18,41 . A disadvantage of nonlongitudinal incisions in routine surgery on the anteromedial part of the knee is that subsequent total or partial knee replacement is mostly performed using a longitudinal incision, and the patient would have two perpendicular and crossing incisions.…”

“…Ojima et al found significantly fewer subjectively and objectively assessed areas of hypoesthesia when a transverse incision was used. Furthermore, they found significantly more patients who were able to kneel and stated this might partially be due to less pain and numbness as the infrapatellar nerve remained intact 18 .…”