Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives
Few donor sites for vascularized reconstruction of convex joint surfaces have been described. We studied the feasibility of a convex vascularized osteochondral graft harvested from the medial femoral condyle and trochlea, on an anatomical and practical point of view.
An injection-corrosion technique was used on 16 fresh cadaver specimens, and completed by a modified Spalteholz clearing. The extra- and intraosseous vascularization of the medial femoral condyle was systematized and the luminal diameter of the arteries was microscopically measured. Radii of curvature of the medial trochlea and of the carpal bones were measured on arthro-CT-scanner reconstructed images.
The periosteal vessels of the medial condyle are responsible for the whole peripheral intraosseous vascularization, without any watershed region. They are fed by the articular branch of the descending genicular artery and/or the superomedial genicular artery. Several constant vascular axes can be found, and may serve as a pedicle for a vascularized osteochondral graft from the medial femoral trochlea. The radii of curvature of this graft do fit those of the proximal carpal row. A simple surgical approach is suggested.
A vascularized graft harvested on the medial femoral trochlea is a technically feasible procedure that could represent a new reconstructive tool for convex joint surfaces. Osteonecrosis of the proximal pole of the scaphoid or Kienböck’s disease are among several situations where such a graft could be beneficial.
KeywordsMedial condyle Trochlea Osteochondral Vascularized graft Osteonecrosis Knee vascularization
This work was made possible thanks to the comprehension and good will of Prof. Pierre Garin, head of the Anatomy department of Namur University (FUNDP).
Conflict of interest statement
- 4.Chettouane I, Kohler R, Dohin B, Brunet-Guedj E, Lecoq C, Chrestian P (2008) Osteochondral autograft for osteochondritis dissecans of the capitulum in adolescent: report of six cases and review of the literature. Rev Chir Orthop Reparatrice Appar Mot 94(5):449–455 [Article in French]PubMedGoogle Scholar
- 7.Depreux R, Mestdagh H, Fontaine C, Moulleront S (1974) Vascularisation artérielle des condyles fémoraux. Lille chir 29(1):32–34Google Scholar
- 8.Doi K, Oda T, Soo-Heong T, Nanda V (2000) Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg 25A:507–519Google Scholar
- 24.Kuhlmann JN, Mimoun M, Boabighi A, Baux S (1987) Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid. J Hand Surg 12(2):203–210Google Scholar
- 28.Masquelet AC, Romana MC, Penteado CV (1989) Vascularized periosteal grafts. In: Aebi M, Regazzoni P (eds) Bone transplantation. Springer, Berlin, pp 259–269Google Scholar