[Arterial supply of the femoral condyles].
BACKGROUND
The most frequent site for aseptic bone necrosis and osteochondrosis dissecans in the human knee joint is the medial femoral condyle. The aim of this study is to analyze the three-dimensional vascularization of the human knee joint and to find out if there are any differences in the blood supply of the medial and lateral femoral condyles which may explain the preponderance of aseptic bone necrosis in the medial side.


METHODS
The femoral arteries of 14 unfixed lower extremities have been injected with epoxy resin. After documentation of the extraosseous course of the blood vessels the bone was macerated with 10% formic acid. The insertions of tendons and ligaments were investigated by light microscopy and immunohistochemistry.


RESULTS
The arterial supply of the lateral femoral condyle originates from the upper lateral geniculate artery, the terminal ends of which penetrate the bone from lateral. Branches of the middle geniculate artery reach the bone from the medial wall of the intertubercular notch. The subchondral bone of the medial femoral condyle draws its blood supply mainly from the descending geniculate artery. Branches of the middle geniculate artery penetrate the medial femoral condyle only in the posterior part of the intercondylar fossa. These posterior vessels do not contribute to the supply of the subchondral bone. In the anterior part of the medial wall of the intercondylar fossa there is the wide femoral insertion of the posterior cruciate ligament. Injection techniques and immunohistochemical investigations show that the fibrocartilage of the chondral apophyseal insertion of the posterior cruciate ligament is avascular and acts as banier which impedes blood vessels to penetrate the bony surface in this region. The subchondral bone adjacent to the femoral insertion of the posterior cruciate ligament receives its blood supply from vessels that penetrate the bone at the medial wall of the medial femoral condyle. The blood vessels which supply the lateral parts of the medial condyle have the longest intraosseous course. The density of vessels within this region is largely reduced.


CONCLUSIONS
The region adjacent to the femoral insertion of the posterior cruciate ligament is the most frequent site for osteochondrosis dissecans in the knee joint. Our results show that the arterial supply of the subchondral bone may be considered as a cofactor for the etiology of osteochondrosis dissecans.
Lankes
M
M
Klinik für Orthopädie, Christian-Albrechts-Universität zu Kiel.
Petersen
W
W
Hassenpflug
J
J
D000368:Aged; D002196:Capillaries / Q000473:pathology; D005260:Female; D005263:Femoral Artery / Q000473:pathology*; D005269:Femur / Q000098:blood supply*; D006801:Humans; D007719:Knee Joint / Q000098:blood supply*; D008023:Ligaments, Articular / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010008:Osteochondritis Dissecans / Q000473:pathology*; D010020:Osteonecrosis / Q000473:pathology*; D012016:Reference Values