Article
Surgical Anatomy of Medial Femoral Based Vascularized Bone Graft Arterial Pedicle
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Published: | February 6, 2020 |
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Objectives/Interrogation: The arterial anatomy of the medial femoral condyle (MFC) vascularized bone graft has been extensively studied in cadaveric specimens. Both the descending genicular and superomedial genicular vessels can be used as the dominant pedicle to the vascularized medial femoral condyle and trochlea grafts. A majority of cadaveric studies have limited numbers of specimens but data from these studies are extrapolated to the surgical environment. The purpose of this study is to evaluate the vascular anatomy of the medial femoral condyle to correlate surgical experience to cadaveric data.
Methods: A retrospective review of operative reports was conducted of medial femoral condyle and trochlea vascularized bone grafts performed by the senior two surgeons between 2005 to 2018 at the Mayo Clinic, Rochester. A total of 95 patients were included in the study. Operative reports were reviewed to determine arterial anatomy as well as dominant pedicle harvested. Demographic data, preoperative diagnosis and type of graft harvested were collected.
Results and Conclusions: The descending genicular artery off the superficial femoral artery was the dominant pedicle, encompassing 76.8% of all donor vessels. 77% of MFC cases (68 of 88 total) utilized the descending genicular. It was also dominant for medial femoral trochlea bone grafts with 5 out of the 7 (71.4%) cases. The superomedial genicular artery was the dominant pedicle in 23% (22 of 88 total) of all cases. Within this group, there were 6 patients who did not have a descending genicular branch thus necessitating the use of the alternate pedicle. The primary finding for all patients in whom the descending genicular was not utilized was inadequate vessel caliber. The superomedial genicular artery was absent in 2% (2 of 95 cases). Pedicle length was adequate for all cases.