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Anatomic bases of a vascularized allogenic knee joint transplantation: arterial blood supply of the human knee joint

Bases anatomiques de la transplantation d'une allogreffe vascularisée de genou : vascularisation artérielle de l'articulation du genou humain

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Summary

The vitality of a graft in a vascularized allogenic knee joint transplantation in humans will depend strongly on maintaining the arterial blood supply to the bone. As can be demonstrated in injected specimens on cadavers, only periostal aa. are important to ensure the blood supply of the human knee joint. The main arteries have defined nutritive areas. According to our results access to the vessels should most probably be conducted from the dorsal side of the knee. During the explantation the popliteal a. should be ligated proximally as high up as possible and distally just above its trifurcation. The articular branch of the descending genicular a. of both the donor and the recipient can be ligated because of a rich anastomotic network. The medial and lateral inferior genicular aa. of the donor should be ligated ventrally as far forward as possible. One should, above all, preserve the medial inferior genicular a. of the donor in order not to endanger the medial part of the distal segment of the graft. If an operation is to be performed according to the results of our anatomical studies, vascularized allogenic knee joint transplantations should be successful from an anatomical point of view.

Résumé

La vitalité d'une greffe lors d'une transplantation d'allogreffe vascularisée de genou dépendra principalement du maintien de la vascularisation artérielle de l'os. Comme on peut le montrer sur des spécimens cadavériques injectés, seules les artères périostées sont importantes pour assurer la vascularisation artérielle du genou humain. Les principales artères ont des territoires définis. En fonction de nos résultats, l'accès aux vaisseaux serait au mieux mené par le versant dorsal du genou. Pendant le prélèvement, l'a. poplitée devrait être sectionnée proximalement aussi haut que possible, et distalement juste au-dessus de sa trifurcation. Le rameau articulaire de l'a. descendante du genou du donneur et celui du receveur peuvent être liées en raison du riche réseau anastomotique. Les aa. géniculées inféro-médiale et inféro-latérale du donneur devraient être liées aussi loin que possible en avant. Il faudrait par dessus tout préserver l'artère géniculée inféromédiale du donneur pour éviter de léser la partie médiale du segment distal de la greffe. Si une transplantation d'un allogreffe vascularisée de genou devait être réalisée en tenant compte du résultat de nos travaux, elle devrait être un succès du point de vue anatomique.

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Kirschner, M., Menck, J. & Hofmann, G. Anatomic bases of a vascularized allogenic knee joint transplantation: arterial blood supply of the human knee joint. Surg Radiol Anat 18, 263–269 (1996). https://doi.org/10.1007/BF01627603

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