A Cadaveric Study of the Branching Pattern and Diameter of the Genicular Arteries: A Focus on the Middle Genicular Artery

Abstract

The aim of the study was to gain an appreciation of the variation in the branching pattern and diameter of the genicular arteries arising directly from the popliteal artery (PA), namely, the superior medial genicular artery (SMGA), superior lateral genicular artery (SLGA), inferior medial genicular artery (IMGA), inferior lateral genicular artery (ILGA), and middle genicular artery (MGA). Twenty cadaveric knees aged between 62 and 92 years were dissected. A posterior midline vertical incision was used to gain access to the PA. The diameter of the PA, the sequence of branching, and subsequent diameter of genicular vessels and common trunks were recorded. PA average diameter was 7.9 mm. The SMGA (1.6-mm diameter) was the first branch in 45% and the second branch in 20%, and in seven limbs it arose from a common trunk with the SLGA. The SLGA was the second branch in 30% and the first branch in 25%, and it branched from a common trunk in 45%. The MGA (1.1-mm diameter) arose as the second branch in four knees and as the third branch in eight knees. It arose from a common trunk in eight knees, either with a superior genicular (three knees) or with an inferior genicular (five knees). The IMGA (1.5-mm diameter) was the third branch in 25%, the fourth branch in 35%, and the fifth branch in 15%. In five cases, it arose from a common trunk (25%). The ILGA (1.4-mm diameter) was the third branch in 15%, the fourth branch in 30%, and the fifth branch in 25%. It arose from a common trunk in six knees. These trunks also gave rise to the IMGA in all cases. There is extensive variation in the branching pattern and diameter of the genicular arteries differing from textbook descriptions. An awareness of vascular variation is imperative for preservation of the blood supply to the knee, which may promote recovery after anterior cruciate ligament reconstruction and popliteal aneurysm repair.

Keywords

branching pattern - genicular - middle genicular artery - cruciate repair

• References

• 1 Rong GW, Wang YC. The role of cruciate ligaments in maintaining knee joint stability. Clin Orthop Relat Res 1987; (215) 65-71
• 2 Salaria H, Atkinson R. Anatomic study of the middle genicular artery. J Orthop Surg (Hong Kong) 2008; 16 (1) 47-49
• 3 Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 7th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014. :xxviii, 1134
• 4 Amis AA, Dawkins GP. Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 1991; 73 (2) 260-267
• 5 Edwards A, Bull AM, Amis AA. The attachments of the fiber bundles of the posterior cruciate ligament: an anatomic study. Arthroscopy 2007; 23 (3) 284-290
• 6 Amis AA, Gupte CM, Bull AM, Edwards A. Anatomy of the posterior cruciate ligament and the meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 2006; 14 (3) 257-263
• 7 Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 2007; 23 (12) 1320-1325.e6
• 8 Toy BJ, Yeasting RA, Morse DE, McCann P. Arterial supply to the human anterior cruciate ligament. J Athl Train 1995; 30 (2) 149-152
• 9 Petersen W, Tillmann B. Blood and lymph supply of the posterior cruciate ligament: a cadaver study. Knee Surg Sports Traumatol Arthrosc 1999; 7 (1) 42-50
• 10 Shim SS, Leung G. Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop Relat Res 1986; (208) 119-125
• 11 Nemschak G, Pretterklieber ML. The Patellar Arterial Supply via the Infrapatellar Fat Pad (of Hoffa): A Combined Anatomical and Angiographical Analysis. Anat Res Int 2012; 2012: 713838
• 12 Last RJ. Specimens from the Hunterian Collection. 3. The genicular arteries (specimen S142 A). J Bone Joint Surg Br 1951; 33B (2) 264-267
• 13 Sinnatamby CS, Last RJ. Last's Anatomy: Regional and Applied. 12th ed. Edinburgh, New York: Churchill Livingstone/Elsevier; 2011. : x, 548
• 14 Diwan A, Sarkar R, Stanley JC, Zelenock GB, Wakefield TW. Incidence of femoral and popliteal artery aneurysms in patients with abdominal aortic aneurysms. J Vasc Surg 2000; 31 (5) 863-869
• 15 Sabalbal M, Johnson M, McAlister V. Absence of the genicular arterial anastomosis as generally depicted in textbooks. Ann R Coll Surg Engl 2013; 95 (6) 405-409
• 16 de Latour B, Nourissat G, Duprey A, Berger L, Favre JP, Barral X. Bypass to the perigeniculate collateral arteries: mid-term results. Eur J Vasc Endovasc Surg 2008; 35 (4) 473-479
• 17 Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M. Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 2012; 11: CD008413
• 18 Dunlap J, McCarthy JA, Joyce ME, Ogata K, Shively RA. Quantification of the perfusion of the anterior cruciate ligament and the effects of stress and injury to supporting structures. Am J Sports Med 1989; 17 (6) 808-810
• 19 Spitzka EAH , ed. Gray's Anatomy. 18th ed. London: Longman Publishing; 1910