Topography of the Middle Genicular Artery is Associated with the Superior and Inferior Genicular Arteries

Yang, Kiwook; Park, Jae-Hee; Jung, Soo‐Jung; Lee, Hyunsu; Choi, In‐Jang; Lee, Jae-Ho

doi:10.4067/s0717-95022017000300019

Cited by 7 publications

(7 citation statements)

References 7 publications

(10 reference statements)

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“…Comparing the studies, we decided to use the posterior tibial plateau as our reference line (joint line) as this is an easily identifiable landmark during surgical procedures. Although we do not know precisely where the anatomic joint line falls in relation to the reference line in theYang et al (2017) study, they showed the ILGA branching from the PA 18.46 mm inferior to the designated reference line and the IMGA branching 24.09 mm inferior to the reference line.…”

mentioning

confidence: 66%

“…The branching location of the five genicular arteries from the PA in the posterior knee as well as the variations in genicular artery branching patterns have previously been studied (Bettaiah, Sangeetha, & Saraswathi, 2016;Yang et al, 2017); however, no F I G U R E 1 Posterior view of the knee at the popliteal fossa. Line A: distance between the genicular artery branch point from the popliteal artery (PA) and joint line (JL) was measured.…”

Section: Anatomymentioning

confidence: 99%

“…Previous work byYang et al (2017) described the branching pattern of the genicular arteries from the PA. In this study, 22 cadavers were used to determine the location of the genicular arteries in relation to a reference line defined as a horizontal line extending from the apex of the patella.…”

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confidence: 99%

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Mapping the genicular arteries to provide a caution zone during knee surgery

et al. 2019

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Introduction Reports from the current literature show a lack of detail with depictions of the genicular arteries (GA). The intricate anatomy and infrequency of operating in the posterior knee may lead to surgeons being unfamiliar with the anatomy. The goal of this cadaveric study was to quantitatively map the arteries and create a caution zone that can be utilized when preparing and performing surgical procedures involving the knee. Materials and methods The left knees of 46 cadavers were used. The distance of the GAs were from the joint line (JL) (+, superior to JL; −, inferior to JL) was measured in two locations: popliteal artery (PA) branch point and medial/lateral knee. The angle the artery traveled between these two points in the posterior knee was measured. A caution map was created. Results The superolateral GA branched from PA at +47.3 mm and traveled superiorly at 57.7° to +52.2 mm at the lateral knee. The superomedial GA branched from PA at +55.2 mm and traveled superiorly at 66.8° to +57.3 mm at the medial knee. The inferolateral GA branched from PA at −0.6 mm. It traveled superiorly at 74.1° or inferiorly at 62.1° to −1.0 mm at the lateral knee. The inferomedial GA branched from the PA at +9.9 mm. It traveled inferiorly at 21.2° to −33 mm at the medial knee. Conclusion The GAs have a predictable pattern of location in the knee. There is a mismatch between medical textbooks and reality regarding arterial depictions. Knowledge regarding where the arteries are located may help reduce vascular complications in patients in the future.

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mentioning

confidence: 66%

Section: Anatomymentioning

confidence: 99%

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Mapping the genicular arteries to provide a caution zone during knee surgery

et al. 2019

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“…Cadaveric studies have previously reported variations in genicular arterial anatomy and proposed two different classification patterns. 18,19 The classification types mainly involve differences in the middle genicular artery (MGA) branching pattern and its common origin with other genicular arteries. The MGA was not treated in the present study given its limited perfusion of the knee.…”

Section: Discussion Classificationmentioning

confidence: 99%

Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization

Bagla¹,

Piechowiak²,

Sajan

et al. 2021

Journal of Clinical Interventional Radiology ISVIR

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Purpose: Genicular artery embolization (GAE) has been proposed as a novel technique to treat painful synovitis related to osteoarthritis. An in-depth understanding of the genicular arterial anatomy is crucial to achieve technical success and avoid nontarget-related complications. Given the lack of previous angiographic description, the present study analyzes genicular arterial anatomy and proposes an angiographic classification system. Materials and Methods: Angiographic findings from 41 GAEs performed during two US clinical trials from January 2017 to July 2019 were reviewed to analyze the anatomical details of the following vessels: descending genicular artery (DGA), medial superior genicular artery (MSGA), medial inferior genicular artery (MIGA), lateral superior genicular artery (LSGA), lateral inferior genicular artery (LIGA), and anterior tibial recurrent artery (ATRA). The diameter, angle of origin, and anastomotic pathways were recorded for each vessel. The branching patterns were classified as: medially, M1 (3/3 arteries present) vs M2 (2/3 arteries present); and laterally, L1 (3/3 arteries present) vs L2 (2/3 arteries present). Results: A total of 91 genicular arteries were embolized: DGA (26.4%), MIGA (23.1%), MSGA (22.0%), LIGA (14.3%), and LSGA/ATRA (14.3%). The branching patterns were: medially = M1, 74.4% (n = 29), M2, 25.6% (n = 10); and laterally = L1, 94.9% (n = 37), L2, 5.1% (n = 2). A common origin for MSGA and LSGA was noted in 11 patients (28.2%). A direct DGA origin from the popliteal artery was reported in three patients (7.7%, n = 3). Conclusions: A thorough understanding of the geniculate arterial anatomy is important for maximizing postprocedural pain reduction while minimizing complications, procedure time, and radiation exposure during GAE.

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“…29 Yang et al subsequently demonstrated that variations in the origin of the middle geniculate artery were associated with substantial variations in the origin of the other arteries of the geniculate system. 30 Salaria et al found the middle geniculate artery formed a near right angle relative to the popliteal artery in flexion, which may place it at risk during tibial preparation in TKA. 32 Any aberrant retractor placement or inadvertent contact with an invasive instrument (i.e., oscillating saw or osteotome), places these delicate vascular structures at risk.…”

Section: Clinical Significancementioning

confidence: 99%

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

et al. 2019

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Total knee arthroplasty (TKA)-associated hemarthroses are infrequent and often respond to nonoperative therapy. Geniculate artery embolization may provide symptomatic relief in cases recalcitrant to needle aspiration, although no meta-analysis exists regarding this therapy. This meta-analysis aims to assess the rate of symptom relief, the number of embolizations needed to achieve relief, and the rate of complications associated with embolization. Public databases were queried from 1998 until 2018 for TKA-associated recurrent hemarthroses treated with embolization. Eight studies met inclusion and exclusion criteria. Major complications were defined as those requiring readmission or nonelective reoperation; minor complications were defined as those not requiring readmission or reoperation. Pooled statistics were calculated utilizing the method of inverse variance. Fifty-nine patients with a mean follow-up of 30 months (range, 1–50 months) were evaluated. The pooled proportion of patients with symptom improvement following embolization was 86% (95% confidence interval [CI]: 74–93%, I 2: 0%, p = 0.97). The average number of embolization procedures was 1.30 (95% CI: 1.03–1.63, I 2: 0%, p = 0.66). The pooled proportion of patients who required a second embolization procedure was 26% (95% CI: 15–40%, I 2: 0%, p = 0.43), while those requiring three or more procedures was 13% (95% CI: 6–25%, I 2: 0%, p = 0.87). The rate of complications were as follows: any complication – 19% (95% CI: 11–32%, I 2: 0%, p = 0.81); major complications–8% (95% CI: 3–19%, I 2: 0%, p = 0.96); minor complications–18% (95% CI: 10–31%, I 2: 0%, p = 0.79); inguinal hematoma–9% (95% CI: 4–19%, I 2: 0%, p = 1.00); skin necrosis–15% (95% CI: 7–29%, I 2: 0%, p = 0.62); and incision breakdown–7% (95% CI: 3–17%, I 2: 0%, p = 1.00). Previous literature on selective artery embolization following TKA is relatively limited. This meta-analysis supports embolization as a potentially safe and effective treatment for recurrent hemarthroses after TKA. Other correctable causes of recurrent hemarthrosis, such as instability or malalignment, must be diligently ruled out prior to utilizing embolization. Surgeons should be aware of embolization's potential role in the postoperative period following TKA.

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Topography of the Middle Genicular Artery is Associated with the Superior and Inferior Genicular Arteries

Cited by 7 publications

References 7 publications

Mapping the genicular arteries to provide a caution zone during knee surgery

Mapping the genicular arteries to provide a caution zone during knee surgery

Angiographic Analysis of the Anatomical Variants in Genicular Artery Embolization

Selective Embolization Is Safe and Effective for Total Knee Arthroplasty-Associated Recurrent Hemarthroses: A Systematic Review and Meta-Analysis

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