Evaluation of the Intraosseous and Extraosseous Blood Supply to the Distal Femoral Condyles

Abstract

Osteonecrosis of the distal femur occurs more often in the medial femoral condyle than in the lateral femoral condyle, but the vascular supply to these regions has not previously been described. Twelve fresh adult cadaver legs were injected with india ink or latex via the femoral artery and then meticulously dissected to evaluate the extraosseous blood supply. After all soft tissue was removed, the intraosseous blood supply was evaluated using a modified Spateholtz technique. The vascular structures at risk during posterior cruciate ligament reconstruction were also identified. The analysis of the extraosseous arterial supply demonstrated that the superior and inferior lateral genicular arteries combine to supply the lateral femoral condyle. The medial femoral condyle is supplied primarily by the superior medial genicular artery and other lesser branches of the popliteal artery. The intraosseous supply to the lateral condyle was shown to consist of an arcade of vessels providing multiple branches to the subchondral bone with no obvious "watershed" region of limited vascularity. The intraosseous supply to the medial condyle appeared to consist of a single nutrient vessel supplying the subchondral bone with an apparent watershed area of limited supply. A potentially significant difference exists between the intraosseous and extraosseous blood supply to the medial and lateral femoral condyles that may explain the higher frequency of ischemic events occurring in the medial femoral condyle. The close proximity of the extraosseous vessels to the medial femoral condyle and the standard femoral tunnel used during posterior cruciate ligament reconstruction may explain the occurrence of avascular necrosis after this procedure.

Conservative Treatment for Juvenile Osteochondritis Dissecans of the Talus

“…6 The first two theories have been rejected because of demonstration of normal vascularity at OCD sites. 7,8 The last theory is supported by an increased incidence of OCD in patients who are very active or involved in competitive sports. For OCD of the talus, both traumatic and ischaemic aetiologies are possible.…”

Injury to neurovascular structures with insertion of traction pins around the knee

“…Traditional teaching has utilized this knowledge to place distal femoral and proximal tibial skeletal traction pins in specific directions and through zones that minimize damage to nearby neurovascular structures. 2,6,7,9 Our study shows that distal femoral and proximal tibial Kirschner wires are able to be inserted using traditional guidelines while maintaining an adequate safe distance from nearby neurovascular structures. Traditional teaching dictates femoral pin insertion from medial to lateral to minimize damage to the femoral artery and vein as they traverse Hunter's canal as well as proximal tibial pin insertion from lateral to medial to minimize damage to the superficial peroneal nerve.…”

Osteochondritis Dissecans Knee Histology Studies Have Variable Findings and Theories of Etiology

“…Trauma could then cause the articular cartilage to fracture and result in a loose body within the joint. Several studies have questioned the presence of an ischemic zone in the lateral aspect of the medial femoral condyle [4,10,21,22]. Furthermore, the ischemic zone theory seems implausible when OCD is more common in young patients, because these patients probably have a good distal femoral blood supply [29], and OCD lesions occur in other locations in the knee.…”