title: Periosteal vascularization of the distal femur in relation to distal femoral osteotomies: a cadaveric study.
abstract: BACKGROUND
  The purpose of this study was to investigate periosteal vessels location as intra-operative landmarks in distal femoral osteotomies and focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of distal femoral osteotomies. Anastomoses of relevant vessels were studied to analyze the risk of vascular insufficiency after transection of landmark vessels.
  
  
  METHODS
  A human cadaver dissection study on the vascular supply of the medial and lateral side of the distal femur was conducted. Surgical dissection was performed in eight knees in total. Distances between the vascular supply and bony landmarks were calculated. Relation of the vascular structures to the transverse bone cuts of distal femoral osteotomies was described, as well as anastomoses of relevant vessels.
  
  
  RESULTS
  On the medial side of the distal femur the periosteum was primarily supplied by the descending genicular artery (DGA) in 87.5 % of the specimens. In the absence of the DGA, the superior medial genicular artery was the supplier. Vascularization took place through two constant branches, the upper transverse artery (UTA) and the central longitudinal artery. The UTA originated at a mean distance of 6.9 cm (range 5.9-7.9 cm) above the knee joint line. On the lateral side of the distal femur the superior lateral genicular artery was the main vessel. In all dissected knees it gave off the lateral transverse artery (LTA). The LTA originated at a mean distance of 6.9 cm (range 5.8-7.6 cm) above the knee joint line. Anastomoses between the UTA, LTA and the longitudinal arch of the femoral shaft were found that could prevent vascular insufficiencies after transection of the UTA and LTA.
  
  
  CONCLUSIONS
  The vascular supply of the medial and lateral aspects of the femoral condyle is highly constant. Both the UTA, on the medial side, and the LTA, on the lateral side, can serve as a landmark for orthopedic surgeons in determining the height of the osteotomy cuts in distal femoral osteotomies. Transection of these landmark vessels during the osteotomy will not result in vascular insufficiency because of a collateral supply.
authors.affiliation: Department of Orthopedic Surgery, Limb Reconstruction Center, Maartenskliniek Woerden, Polanerbaan 2, 3447, GN, Woerden, The Netherlands.
authors.forename: J A D
authors.initials: JA
authors.lastname: van der Woude
authors.affiliation: Department of Orthopedic Surgery, Limb Reconstruction Center, Maartenskliniek Woerden, Polanerbaan 2, 3447, GN, Woerden, The Netherlands. vanheerwaarden@yahoo.com.
authors.forename: R J
authors.initials: RJ
authors.lastname: van Heerwaarden
authors.affiliation: Department of Anatomy, University Medical Center, Utrecht, The Netherlands.
authors.forename: R L A W
authors.initials: RL
authors.lastname: Bleys
keywords: Cadaver; Closed-wedge; Distal femoral osteotomy; Distal femur; Periosteal vessels; Surgical technique; Valgus producing; Varus producing; Vascularization