La vascularisation artérielle de la patella humaine : son importance clinique dans la technique opératoire des transplantations vascularisées d'articulation du genou

Abstract

The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o'clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.

Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome

“…The ischaemia could be caused by higher intraosseous pressure, 9 24 by redundant axial loading, 25 or by decreased arterial blood flow. 26 PFPS, stress fractures, and medial tibial stress syndrome (MTSS) can be visualised on bone scintigraphy. 17 27 28 The appearance of mild increased uptake on bone scintigraphy relates to the mildest form of bone stress and is a sign of accelerated remodelling.…”

Importance of Arterial Blood Supply to the Femur and Tibia for Transplantation of Vascularized Femoral Diaphyses and Knee Joints

“…Furthermore, anatomic studies of the knee joint were published without clinical experience. Meanwhile three transplantations of allogenic, vascularized diaphyses of the femur and four knee joint transplantations have been performed [10,20,21]. Based on the anatomic knowledge so derived, the operating technique has been modified for both types of transplantation.…”

“…The patellar blood supply is not compromised, as the other arteries are able to supply the "circular artery" (Fig. 3) [21]. If more of the tibial bone is needed (up to approximately 11.5 cm), it is advisable to ligate the three arteries below the trifurcation (i.e., Ͼ7 cm below the tibial plateau.…”

The Patellar Arterial Supply via the Infrapatellar Fat Pad (of Hoffa): A Combined Anatomical and Angiographical Analysis

“…Both, the medial and the lateral superior polar vessels, formed an anastomosis in the superior aspect of the patella. Due to different techniques applied, this anastomosis together with its course had obviously been overlooked by other authors [10–13]. …”

“…Especially the descending genicular artery, the medial and lateral superior genicular arteries, the medial and lateral inferior genicular arteries, and the anterior tibial recurrent artery contribute to this so-called Rete patellae. These arteries are also involved in the supply of the distal parts of the femur and the proximal aspects of the tibia [10]. The two superior genicular arteries run along the superior pole of the patella forming an anastomosis together with the descending genicular artery anterior to the insertion of the quadriceps tendon.…”