Blood Supply Of The Structures Of The Knee
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Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
The important blood supply of the structures of the knee comes from two sources and I use this approach for simplification purposes and also for remembering the blood supply around the knee.
•Popliteal artery (posterior aspect of the knee)
•Anterior tibial artery: there is a branch of the anterior tibial artery called the recurrent anterior tibial artery which is close to the tibial tubercle. When there is a tibial tubercle fracture, this branch of the anterior tibial artery becomes injured and the patient may develop compartment syndrome. In this injury, you must address the presence of the tibial tubercle fracture and also address the possibility of compartment syndrome.
Growth plate fracture of the proximal
When the fracture goes through the entire tibial physis, the patient is a risk of developing injury to the popliteal artery.
•Popliteal artery (posterior aspect of knee)
•Medial superior genicular artery
•Lateral superior genicular artery
•Medial inferior genicular artery
•Lateral inferior genicular artery
•Middle inferior genicular artery
These are the type of questions that are found on the exam related to the blood supply around the knee. The peripheral portion of the medial and lateral menisci is vascular and if you repair it, it will heal. A peripheral tear in the red zone will heal if it is repaired.
Where does the blood supply of the meniscus come from?
The blood supply of the medial and lateral menisci originates from the medial and lateral inferior genicular arteries. The medial inferior genicular artery and lateral inferior genicular arteries supply approximately 20-30% of the meniscus (peripheral area) with blood supply. This is the area where if you repair the meniscus, then it will heal (location of the tear is important).the posterior horn of the meniscus is supplied by the middle genicular artery. In general, the meniscus is supplied by the inferior genicular artery. Approximately 75% of the meniscus is avascular. The medial and lateral inferior genicular arteries also supply the infrapatellar fat pad and the patellar tendon. The patellar tendon may recive some blood supply contribution from the anterior tibial recurrent artery. The middle genicular artey gives blood supply to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Middle genicular artey may also supply the posterior horn of the meniscus.
The medial and lateral superior genicular arteries supply the medial and lateral retinaculum.
The lateral superior genicular artery is at risk of being injured during lateral retinacular release. The lateral superior genicular artery may be the only remaining blood supply to the patella after a medial parapatellar approach and fat pad excision. Some physicians think that it may contribute to avascular necrosis and patellar fractures after total knee replacement.
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