. Manual of operative surgery. Fig. 1279.—Drainage knee. {Peck.) downwards and divides the tendo patellae. Divide the anterior capsule, bothlateral and both crucial ligaments, leaving the posterior ligaments alone a lateral cut on each side upwards so as to permit the complete turningupwards of the anterior flap, including the patella and all tissue down to thejoint (Fig. 1280). This exposes every nook and cranny of the upper synovialpouch. Keep the patellar flap in its new position by means of a stitch uniting AKTIIKOTOMY 1029 it to the skin of the thigh. The rest of the operation
. Manual of operative surgery. Fig. 1279.—Drainage knee. {Peck.) downwards and divides the tendo patellae. Divide the anterior capsule, bothlateral and both crucial ligaments, leaving the posterior ligaments alone a lateral cut on each side upwards so as to permit the complete turningupwards of the anterior flap, including the patella and all tissue down to thejoint (Fig. 1280). This exposes every nook and cranny of the upper synovialpouch. Keep the patellar flap in its new position by means of a stitch uniting AKTIIKOTOMY 1029 it to the skin of the thigh. The rest of the operation is the same as that alreadydescribed. After recovery from the infective process has taken place, Peckand others recommend performing arthrectomy, arguing that even if it waspossible to obtain closure of the wound without removing the articular surfaces,yet there would be no chance of getting a useful joint and there would be a. Fig. 1280.—Drainage knee. {Peck.) probabihty of fibrous anchylosis with subluxation of the tibia on the the author it seems wise not to adopt any hard and fast rule; if reduction andretention of the articular surfaces in proper position is easy then endeavor toobtain a more or less mobile joint, if this fail it is easy to resect at a later date. Remarks on Arthrotomy.—(The general principles here enunciated applyequally to other joints.) For exploratory purposes unilateral or bilateral incisions are commonlysufficient though for many purposes in the absence of infection Robert Jones* 1030 KNEE-JOINT median section of the patella is of extraordinary value. The preliminary in-jection of Formalin-Glycerine urged by J. B. Murphy is unnecessary as thesynovialis is really resistant to infection. When the exploration is completed,close the wound in the synovialis with accuracy and then suture the more super-ficial structures. To avoid possible anchylosis, Willems insists on acti
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