The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study

Inferior Medial Geniculate Artery Branch as an Anatomical Landmark for Hamstring Harvest During Anterior Cruciate Ligament Reconstruction

Graft harvesting is often a challenging step of anterior cruciate ligament reconstructions. Accurate isolation of the hamstring tendons at the pes anserinus is crucial to successful graft harvesting. We describe a technique of using a branch of the inferior medial geniculate artery overlying the pes anserinus insertion as an anatomical landmark to localize the hamstring tendons for harvest. By using this vessel as an anatomical landmark, the incision length was decreased and the time required to harvest reduced. This is a highly reproducible technique and will be beneficial for soft tissue harvesting surgeons to ease hamstring graft harvesting.

Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types

Literature concerning anterior cruciate ligament (ACL) reconstruction has increased in both scope and sophistication during the last decades. Heretofore, the principle focus has been on graft choice comparisons, the appropriate handling of co-injuries such as meniscal tears, cartilage lesions, as well as extra-articular ligament injuries. Despite the accumulated knowledge, there is still a lack of clarity concerning a therapy algorithm for different rupture types. With different consequences in therapy strategy, rupture types were differentiated as (1) subsynovial ACL tears/stretch injury and proximal avulsion tears, (2) single-bundle tear (anteromedial/posterolateral), and (3) total ACL rupture. The article presented here provides an overview of recommended operative therapy strategies for different rupture types of the ACL. Within the past decade, advances in arthroscopic technology coupled with rigorous scientific inquiry have resulted in significantly improved treatment options. With these developments in mind, ACL surgery and postoperative therapy can and should be performed in a manner befitting the patient's individual circumstances. Furthermore, intra- and postoperative suggestions including vancomycin graft-coating, as well as an accelerated "Early Active Rehabilitation" program, including early active physiotherapy without postoperative bracing, as well as additional postoperative extracorporeal shock-wave therapy are recommended.

Vascular coverage of the anterior knee region - an anatomical study

Descriptions of vessel angiosomes or perforasomes throughout the human body are quite frequent, and led to the development of flaps nowadays commonly used to surgically cover skin and soft tissue defects. In these procedures, the surgeon requires a profound anatomical knowledge of the respective blood vessels and the extent of the perfused area to define the size of the graft. In the region of the knee joint, descriptions of flaps based on the superior lateral genicular artery and descending genicular artery are quite frequent. In contrast, information regarding other popliteal branches is scarce or non‐existent. The aim of this study was to provide a concise and complete overview on the extent and variability of the perforator angiosomes of the femoral and popliteal arteries in the anterior knee region. Twenty lower extremities were dissected, the respective perforators identified and perfused with dye. All resulting angiosomes were marked and documented. A total of 84 angiosomes were identified in all specimens, with an average of 4.2 (3–6) angiosomes per specimen. The average size of the angiosomes was 97.04 ± 72.30 cm² (8.61–360.41 cm²), their source vessels had an average diameter of 1.42 ± 0.54 mm (0.60–3.25 mm). The complex and highly variable distribution of perforator angiosomes of the anterior knee region and especially of its less frequently investigated distal part was demonstrated. Based on these results, the planning of existing perforator flaps in this region and the development of flaps including the inferior medial or inferior lateral genicular arteries may be facilitated.