On the surgery of the knee-joint : and the responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley.

  • Keetley, Charles Bell, 1848-1909.
Date:
[1888]
Catalogue details

Licence: Public Domain Mark

Credit: On the surgery of the knee-joint : and the responsibility placed on the physician and general practitioner by the modern progress of surgery : being the inaugural and retiring presidential addresses delivered before the West London Medico-Chirurgical Society, on October 7th, 1887, and May 4th, 1888, respectively / by C.B. Keetley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the eyes of the surgeon and his assistants, especially if it has been long kept. The manner of opening the joint is very important. For a thorough exploration of the knee-joint a trans- verse incision is essential, and it must be supplemented by a perpendicular incision to open the synovial pouch, which extends upwards beneath the extensor cruris. The transverse incision may divide either the patella itself or the ligamentum patellae; preferably the former, I think. A strong knife will cut a child’s patella, but an adolescent or adult requires a saw. I prefer to divide the patella because (l) it can be so easily, certainly, and perfectly reunited ; and (2, a minor and almost superfluous argument) the section shows accurately the condition of the centre of the bone. I doubt whether a sutured ligament is as strong and trustworthy as a sutured bone. Therefore one should, if possible, avoid dividing the lateral ligaments. When divided they should be carefully sutured at the conclusion of the operation. A short supplementary incision may be made anywhere, if required to expose any otherwise inaccessible angle or crevice. In the West London Hospital, some years ago,* I introduced a new mode of opening the joint, ap- plicable when it is not infected with tubercular disease —e.g.f when excision is to be done for injury or for orthopaedic purposes, and particularly applicable as an exploratory incision in cases of injury to the knee- joint. It consists in a long perpendicular incision through the patella, ligamentum patellae, and anterior wall of the upper synovial pouch. Ollier of Lyons * September nth, 1883.