Objective To conduct an in-depth anatomic study on the posterior relevant structures of the knee joint, so as to provide more appropriate approach for the surgical treatment of posterolateral tibial plateau fractures. Methods A total of 10 knee joints of 5 adult cadaveric specimens that were fixed by formaldehyde were observed to learn its anatomic structure through the hierarchical dissection of the posterior knee. The distribution and morphological characteristics of the posterior knee muscles, as well as the course of the associated vessels and nerves, were observed. The diameters and positional relationships of the popliteal artery, posterior tibial artery, anterior tibial artery, peroneal artery, and tibial nutrient artery were measured. Additionally, relevant data of the popliteus, soleus, and gastrocnemius muscles were recorded. Results There were three anatomical structures and features: bare triangle, cushion-like protection, and pouch-like space behind the tibial plateau. The popliteal artery and the posterior tibial artery were located in the lateral one-third of the proximal tibia and along the lateral border of the tibia. These anatomical features determined that medial approach with lateral traction could provide optimal exposure of the posterolateral tibial plateau. The morphological characteristics and related data of the popliteus muscle exhibited discrepancies from the current anatomical literature. The distances from the popliteal artery and posterior tibial artery to the medial and lateral borders of the tibia measured in the coronal plane were (2.98±0.26) cm and (1.73±1.14) cm, respectively, showing significant differences (P<0.05, t=9.547, P=0.000). The heights from the origins of the anterior tibial artery, peroneal artery and tibial nutrient artery to the tibial plateau were (5.33±0.44) cm, (10.40±0.28) cm, and (10.59±0.23) cm, respectively, their outer diameters were (4.91±0.17) mm, (2.28±0.24) mm, and (1.44±0.08) mm, respectively. The angle between the medial vertical border and the superior border of the popliteal muscle was approximately 120°, with the length of the superior border (4.11±0.07) cm and the length of the medial vertical border (8.68±0.13) cm. Additionally, relevant data for the gastrocnemius and soleus muscles was obtained. The area of the bare triangle was (4.36±0.15) cm². Conclusions There is a "subtle" pathway from the posteromedial to the posterolateral tibial plateau, through which a muscular cushion-like structure protects the critical neurovascular structures at posterior aspect of the knee joint. This approach allows for full exposure, reduction, and fixation of posterolateral tibial plateau fractures, offering advantages such as safety, simplicity, and minimally invasive technique.
Key words
Surgical approach; /
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Tibial plateau fractures; /
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Posteromedial; /
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Posterolateral; /
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Applied anatomy
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