title: The inferior medial genicular artery and its vascularization of the pes anserinus superficialis: A cadaveric study.
abstract: BACKGROUND
  A common method for reconstruction of the anterior cruciate ligament (ACL) is it's replacement by a free avascular graft, using the gracilis and/or semitendinosus tendons. These grafts pass a vulnerable phase in the ligamentization-process during the 1styear after reconstruction. The aims of this study were first to evaluate the vascularization of the pes anserinus superficialis (PAS) by the inferior medial genicular artery (IMGA) and second to develop a pedunculated surgical technique for ACL reconstruction, to preserve a maximal amount of natural vascularization of the tendons inserting at the PAS.
  
  
  METHODS
  First, the vascularization of the PAS was assessed in 12 fresh-frozen lower extremities. The IMGA was identified at its origin at the popliteal artery and perfused with a methylene blue solution. Second, a pedunculated ACL reconstruction was performed in 5 fresh-frozen lower extremities under maintenance of the distal tendon insertion at PAS.
  
  
  RESULTS
  The PAS is a highly vascularized structure. Vessels originate from the IMGA, running along the three tendons of the PAS in the paratendinous tissue. Histologically intratendinous vessels exist; however, perfusion of the inserting tendons through intratendinous vessels was not proven macroscopically. The pedunculated grafts could be positioned and fixed successfully into the bone tunnels in all knees.
  
  
  CONCLUSIONS
  Although intratendinous vascularization of the tendons of the PAS via the IMGA was not proven, this study indicates a new possibility of ACL reconstruction. The described operation technique can be conducive to shorten the vulnerable phase of the graft-ligamentization after ACL reconstruction.
authors.affiliation: Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
authors.forename: Lena
authors.initials: L
authors.lastname: Hirtler
authors.affiliation: Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ederer
authors.affiliation: Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
authors.forename: Mike
authors.initials: M
authors.lastname: Faber
authors.affiliation: Department of First Orthopedic, Orthopaedic Hospital Speising, Vienna, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Weninger
keywords: Anterior cruciate ligament reconstruction; arthroscopy; grafts; inferior medial genicular artery; knee injuries; pedunculated graft; pes anserinus superficialis; vascularization