A detailed anatomical description of the subvastus region and its clinical relevance for the subvastus approach in total knee arthroplasty

Abstract

The subvastus region and its anatomical contents are important when performing a total knee replacement via a subvastus approach. Thirty-two human cadaver thighs were studied to provide a detailed anatomical description of the subvastus region and its contents, namely the descending genicular artery and its branches, and the saphenous nerve proximally. In 24 specimens the descending genicular artery arose from the femoral artery and divided into osteoarticular and saphenous branches, while in eight specimens it was absent. The osteoarticular and saphenous branches arose independently from the femoral artery. On the basis of these distribution patterns nine variations with regard to the number and origin of the muscular, musculoarticular and saphenomusculoarticular branches arising from these vessels could be identified. The musculoarticular branch should be preserved wherever possible; however, if it must be sacrificed to improve exposure of the knee joint via a proximal extension of the incision, the passage of the saphenous nerve and the saphenous branch through the vastoadductor membrane are additional structures which must be considered. The proximal limitation for the mobilisation is the adductor hiatus, with further mobilisation increasing the risk of damaging the femoral artery and vein.

Anatomy of the Vascularized Lateral Femoral Condyle Flap

“…19 Scheibel et al indicated that the three branches of the descending genicular artery have one common origin, whereas the anatomical studies conducted by Hertel and Masquelet or Ballmer and Masquelet showed that, in most cases, all of the branches have independent origins. [44][45][46] These findings led us to conclude that the pedicles of the medial femur condyle flap have an abundance of anatomical variation.…”

“…The limitation is, in part, attributable to the wide anatomical variation of the descending genicular artery, which has been observed in anatomical studies focusing on the medial descending genicular artery. 19,44,45 Dubois et al described five branch possibilities of the descending genicular artery. 19 Scheibel et al indicated that the three branches of the descending genicular artery have one common origin, whereas the anatomical studies conducted by Hertel and Masquelet or Ballmer and Masquelet showed that, in most cases, all of the branches have independent origins.…”

Classification and Localization ofthe Adductor Hiatus: A Cadaver Study

“…The importance of this safe interval was also emphasized by Scheibel et al (20). In their study related with total knee replacement via a subvastus approach, they reported that the proximal limitation for the mobilization was the AH, in order not to damage the femoral artery and vein (20).…”

Vascular coverage of the anterior knee region – an anatomical study

“…The DGA originates from the femoral artery at the level of the adductor hiatus Koshima et al 1988;Martin et al 1991;Scheibel et al 2002;Pan & Taylor, 2009;Dubois et al 2010;Yamamoto et al 2010;Rahmanian-Schwarz et al 2011;Gocmen-Mas et al 2012) and has been described to subdivide itself into three main branches a saphenous branch, a muscular branch and an osteoarticular branch (Hertel & Masquelet, 1989;Martin et al 1991;Ballmer & Masquelet, 1998;Scheibel et al 2002;Dubois et al 2010;Yamamoto et al 2010;Gocmen-Mas et al 2012;Garcia-Pumarino & Franco, 2014). The classification of three Table 3) does not only show a relative frequency of these patterns, but also explains why the muscular branch and the osteoarticular branch are often described as musculoarticular branch due to their frequent occurrence as common trunk Gocmen-Mas et al 2012).…”