Remove the skin and superficial fascia from the posterior thigh.  Incise the fascia lata in the midline of the thigh and reflect it to show the musculature.  Relocate the sciatic nerve and ischial tuberosity. Identify the hamstrings from lateral to medial:

• Long head of the biceps femoris
• Semitendinosus
• Semimembranosus

Incise the membrane between the long head of the biceps femoris and semimembranosus to expose the course of the sciatic nerve and its major branches. The tibial nerve is medial and common peroneal (fibular) division is lateral.

On the lateral thigh locate the:

• Short head of biceps femoris
• Tensor fascia lata
• Iliotibial tract (tendon of tensor fascia lata)

Retract the biceps femoris and sciatic nerve laterally and the semitendinosus and semimembranosus medially. This exposes the adductor hiatus where the femoral vessels pass through the opening in adductor magnus to become popliteal artery and vein.

More proximally, identify perforating branches of the deep (profunda) femoral artery.

Incise and reflect the deep or crural fascia of the leg distal to the popliteal fossa to expose popliteal fossa.

Identify the boundaries of the popliteal fossa:

• Lateral gastrocnemius
• Medial gastrocnemius
• Biceps femoris
• Semimebranosus
• Semitendinosus

Locate the position of the joint line by palpating the femoral condyles and tibial plateau. Flexion and extension of the knee may help in this localization.

Re-identify the branches of the sciatic nerve in the popliteal fossa: common peroneal and tibial nerves.

Retract the tibial and common peroneal nerves to show the popliteal artery and vein. The artery will be deep to the vein.

Incise the proximal attachment of the lateral gastrocnemius on the lateral condyle of the femur and reflect it medially.

Identify the soleus and plantaris muscles, which are deep to the lateral gastrocnemius. The soleus and plantaris join the lateral and medial gastrocnemius to form the Achilles (calcaneus) tendon. As a group, these muscles are called the triceps surae.

On the lateral leg, reflect the crural fascia. Identify the peroneus longus, which originates at the proximal fibula.  Divide this muscle proximally. This will expose the superficial and deep peroneal nerves.

Note whether these nerves have been compressed against the neck of the fibula.

In the popliteal fossa, retract the common peroneal nerve laterally and the popliteal vein, tibial nerve and medial gastrocnemius medially.

Divide plantaris proximally and reflect inferiorly to expose the popliteal artery and its genicular branches. These genicular branches form anastomoses around the knee to provide circulation during flexion and extension.

Retract the popliteal artery medially to expose the posterior capsule of the knee joint.

Identify:

• Shaft of femur
• Medial and lateral condyles of femur and tibia
• Posterior capsule of knee joint

Examine the knee of an articulated skeleton. 

Incise the capsule to enter the knee joint. Identify:

• Medial and lateral condyles of femur
• Medial and lateral condyles of tibia
• Posterior cruciate ligament (PCL)
• Medial and lateral menisci

PCL extends from the posterior intracondylar region of the tibia to the medial condyle of the femur. Anterior cruciate ligament (ACL) will be better seen anteriorly. Note the cruciates are named for their tibia attachments.

Examine the knee from a lateral perspective. Remove the crural fascia from the lateral knee. Identify the:

• Patella
• Patellar ligament
• Tibial tuberosity

Identify the lateral collateral ligament extending from the head of fibula to the lateral condyle of the femur.

Examine the knee from a medial perspective. Identify the following thigh muscles:

• Sartorius
• Gracilis
• Semitendinosus

Note these muscles insert together at the pes anserinus on the tibia. Incise the pes anserinus and reflect to reveal the medial collateral ligament. This ligament extends from medial epicondyle to tibia and is attached to medial meniscus.

Examine the knee from an anterior perspective. Divide the fascia lata superior and the crural fascia inferior to the patella. By convention, the tendon of the quadriceps is called the quadriceps tendon superior to the patella and patellar ligament inferior.

Identify the:

• Rectus femoris
• Vastus medialis
• Vastus lateralis
• Quadriceps tendon
• Patellar ligament
• Tibial tuberosity

Incise the patellar ligament close to the tibial tuberosity. Divide the medial and lateral retinacula along the borders of the patella. Mobilize the patella superiorly.

Identify articular cartilages of the patella and femur and the suprapatellar bursa.

Note the complexity and extent of these joint surfaces.

Flex the knee to expose the joint space. Note the articulation between femur and tibia.

Identify the infrapatellar synovial fold extending from tibia to intracondylar region of the femur.

Remove the fold to reveal the ACL, medial and lateral menisci and tibial plateau.

ACL tears are common athletic injuries involving pivoting movements.

Disarticulate the knee by further flexing it while dividing ACL and PCL close to femur. Divide the tendons that cross the joint as well as the vessels and nerves.

On the inferior surface of the femur, identify the ACL and PCL attachments.

On the superior surface of the tibia, identify:

• Medial meniscus
• Lateral meniscus
• ACL and PCL
• Patellar ligament
• Medial collateral ligament

On the posterior leg, remove the muscle covering the proximal tibia and fibula taking care to preserve the popliteal artery and its distal branches.

Identify the interosseous membrane between the tibia and fibula and note the anterior and posterior branching of the artery. The anterior tibial artery can be palpated distally as the dorsalis pedis on the dorsum of the foot. The posterior tibial artery can be palpated distally posterior to the medial malleolus.

On the lateral leg and ankle, incise the crural fascia which covers the lateral compartment to identify the peroneus longus.

Posterior to the lateral malleolus locate:

• Sural nerve
• Lesser saphenous vein
• Achilles tendon
• Calcaneal tuberosity

Incise the peroneal retinaculum posterior to the lateral malleolus along the peroneus longus and brevis into the foot.

On the dorsum of the foot, identify the tendons of:

• Tibialis anterior
• Extensor hallucis longus (EHL)
• Extensor digitorum

Separate the tendons of EHL and extensor digitorum longus to locate the dorsalis pedis artery. This is a pulse point.

On the medial foot and ankle locate the:

• Calcaneal tuberosity
• Achilles tendon
• Medial malleolus
• Great saphenous vein
• Tibialis anterior

Incise and reflect the flexor retinaculum between the medial malleolus and the calcaneal tuberosity to expose the tarsal tunnel. Identify the tendons of the tibialis posterior and flexor digitorum longus.

Posterior to the flexor digitorum longus, locate the posterior tibial vessels and tibial nerve. This location is a pulse point for the posterior tibial artery.

Posterior to the tibial vessels and nerve, locate the flexor hallucis longus.

Follow branches of the tibial nerve distally to the calcaneus and sole of foot.

Compression of the tibial nerve analogous to carpal tunnel syndrome occurs at the tarsal tunnel.

Make a transverse incision across the lower leg 10 to 20 cm above the malleoli.

With a large knife and hand saw, divide the foot and ankle sagittally lateral to the great toe to the mid-tibia and mid-calcaneus. Identify the:

• Tibia
• Talus
• Calcaneus
• Navicular
• Medial cuneiform
• First metatarsal

Plantar flexion and dorsiflexion occur at the tibiotalar joint. Inversion and eversion are subtalar.