Abstract
BackgroundThe purpose of this study was to investigate periosteal vessels location as intra-operative landmarks in distal femoral osteotomies and focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of distal femoral osteotomies. Anastomoses of relevant vessels were studied to analyze the risk of vascular insufficiency after transection of landmark vessels.MethodsA human cadaver dissection study on the vascular supply of the medial and lateral side of the distal femur was conducted. Surgical dissection was performed in eight knees in total. Distances between the vascular supply and bony landmarks were calculated. Relation of the vascular structures to the transverse bone cuts of distal femoral osteotomies was described, as well as anastomoses of relevant vessels.ResultsOn the medial side of the distal femur the periosteum was primarily supplied by the descending genicular artery (DGA) in 87.5 % of the specimens. In the absence of the DGA, the superior medial genicular artery was the supplier. Vascularization took place through two constant branches, the upper transverse artery (UTA) and the central longitudinal artery. The UTA originated at a mean distance of 6.9 cm (range 5.9–7.9 cm) above the knee joint line. On the lateral side of the distal femur the superior lateral genicular artery was the main vessel. In all dissected knees it gave off the lateral transverse artery (LTA). The LTA originated at a mean distance of 6.9 cm (range 5.8–7.6 cm) above the knee joint line. Anastomoses between the UTA, LTA and the longitudinal arch of the femoral shaft were found that could prevent vascular insufficiencies after transection of the UTA and LTA.ConclusionsThe vascular supply of the medial and lateral aspects of the femoral condyle is highly constant. Both the UTA, on the medial side, and the LTA, on the lateral side, can serve as a landmark for orthopedic surgeons in determining the height of the osteotomy cuts in distal femoral osteotomies. Transection of these landmark vessels during the osteotomy will not result in vascular insufficiency because of a collateral supply.
Highlights
The purpose of this study was to investigate periosteal vessels location as intra-operative landmarks in distal femoral osteotomies and focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of distal femoral osteotomies
Discontinuing vascularity by cutting, suturing or coagulating vessels may cause vascular insufficiency. This has been studied with regard to the use of vascular bone grafts of the medial femoral condyle (Yamamoto et al 2010; Iorio et al 2011; Hugon et al 2010; Huang et al 2011). For both the medial and lateral side of the distal femur, the arterial supply was analyzed to find out if there are any differences in blood supply of the medial and lateral femoral condyles to explain the preponderance of osteonecrosis on the medial side (Reddy and Frederick 1998; Lankes et al 2000)
This study focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of the transverse osteotomy cuts in distal femoral osteotomies
Summary
The purpose of this study was to investigate periosteal vessels location as intra-operative landmarks in distal femoral osteotomies and focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of distal femoral osteotomies. Discontinuing vascularity by cutting, suturing or coagulating vessels may cause vascular insufficiency This has been studied with regard to the use of vascular bone grafts of the medial femoral condyle (Yamamoto et al 2010; Iorio et al 2011; Hugon et al 2010; Huang et al 2011). For both the medial and lateral side of the distal femur, the arterial supply was analyzed to find out if there are any differences in blood supply of the medial and lateral femoral condyles to explain the preponderance of osteonecrosis on the medial side (Reddy and Frederick 1998; Lankes et al 2000). Damage to small- and mediums-size vessels may be important to consider as a predisposing factor for delayed union and non-union of femoral osteotomies (Vena et al 2013) and it is important to know whether anastomoses are present preserving blood supply to the condylar area
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
