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Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
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Abstract

Purpose

Genicular artery embolisation (GAE) is a novel treatment for patients with knee osteoarthritis (OA). Cadaveric dissection was undertaken to provide a complete description of the relevant arterial anatomy in order to perform safe and effective GAE.

Materials

Twenty human lower limb specimens were dissected. The morphology of the genicular arteries and presence of anastomotic connections was recorded and compared with angiographic images from patients having undergone GAE. Vessels were measured to investigate the risk of non-target embolisation (NTE), taking a diameter of 300 microns as the threshold for significance.

Results

The descending genicular artery (DGA) is the dominant vessel in medial OA, with 95% of cases revealing vessel division into muscular, saphenous and osteoarticular branches from a single pedicle. The superior medial genicular artery (SMGA) had a shared origin with the middle genicular artery (MGA) in 25% of cases. NTE to the MGA may damage the cruciate ligaments. In 85% of cases, there was an anastomosis between the DGA and SMGA, often encountered at angiography. The mean diameter of the anastomoses was 850 micron, presenting a risk for NTE. An anastomosis between the Inferior Medial Genicular Artery (IMGA) and medial sural artery was found in 5% of cases; the medial sural artery supplies blood to the tibial nerve and should be avoided. The IMGA and inferior lateral genicular artery provided supply to the patellofemoral joint in 69% and 88% of cases, respectively.

Conclusion

An in-depth knowledge of genicular artery anatomy is required for interventional radiologists to perform safe and effective GAE in patients with knee osteoarthritis.

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References

  1. Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine. 2018;29–30:1–13. https://doi.org/10.1016/j.eclinm.2020.100587.

    Article  Google Scholar 

  2. Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745–59. https://doi.org/10.1016/S0140-6736(19)30417-9.

    Article  CAS  PubMed  Google Scholar 

  3. NICE. Managing osteoarthritis [Internet]. 2014 [cited 24/01/21]. Available from: https://pathways.nice.org.uk/pathways/osteoarthritis#path=view%3A/pathways/osteoarthritis/managing-osteoarthritis.xml&content=view-index

  4. Rönn K, Reischl N, Gautier E, Jacobi M. Current surgical treatment of knee osteoarthritis. Arthritis. 2011;2011:1–9. https://doi.org/10.1155/2011/454873.

    Article  Google Scholar 

  5. Evans JT, Walker RW, Evans JP, Blom AW, Sayers A, Whitehouse MR. How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019;393:655–63. https://doi.org/10.1016/S0140-6736(18)32531-5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Tay KS, Lo NN, Yeo SJ, Chia SL, Tay DKJ, Chin PL. Revision total knee arthroplasty: causes and outcomes. Ann Acad Med Singapore. 2013;42:178–83.

    PubMed  Google Scholar 

  7. Petersen KK, Simonsen O, Laursen MB, Nielsen TA, Rasmussen S, Arendt-Nielsen L. Chronic postoperative pain after primary and revision total knee arthroplasty. Clin J Pain. 2015;31:1–6. https://doi.org/10.1097/AJP.0000000000000146.

    Article  PubMed  Google Scholar 

  8. Little M, Gibson M, Briggs J, Speirs A, Yoong P, Ariyanayagam T, Davies N, Tayton E, Tavares S, MacGill S, McLaren C, Harrison R. Genicular artery embolization in patients with osteoarthritis of the knee (GENESIS) using permanent microspheres: interim analysis. Cardiovasc Intervent Radiol. 2021;44:931–40. https://doi.org/10.1007/s00270-020-02764-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lee SH, Hwang JH, Kim DH, So YH, Park J, Cho SB, et al. Clinical outcomes of transcatheter arterial embolisation for chronic knee pain: mild-to-moderate versus severe knee osteoarthritis. Cardiovasc Intervent Radiol. 2019;42:1530–6. https://doi.org/10.1007/s00270-019-02289-4.

    Article  PubMed  Google Scholar 

  10. Landers S, Hely R, Page R, Maister N, Hely A, Harrison B, et al. Genicular artery embolization to improve pain and function in early-stage knee osteoarthritis-24-Month pilot study results. J Vasc Interv Radiol. 2020;31:1453–8. https://doi.org/10.1016/j.jvir.2020.05.007.

    Article  PubMed  Google Scholar 

  11. Okuno Y, Korchi AM, Shinjo T, Kato S, Kaneko T. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28:995–1002. https://doi.org/10.1016/j.jvir.2017.02.033.

    Article  PubMed  Google Scholar 

  12. Bagla S, Piechowiak R, Hartman T, Orlando J, Del Gaizo D, Isaacson A. Genicular artery embolization for the treatment of knee pain secondary to osteoarthritis. J Vasc Interv Radiol. 2020;31:1096–102. https://doi.org/10.1016/j.jvir.2019.09.018.

    Article  PubMed  Google Scholar 

  13. Mapp PI, Walsh DA. Mechanisms and targets of angiogenesis and nerve growth in osteoarthritis. Nature Revi Rheumatol. 2012;8:390. https://doi.org/10.1038/nrrheum.2012.80.

    Article  CAS  Google Scholar 

  14. Casadaban LC, Mandell JC, Epelboym Y. Genicular artery embolization for osteoarthritis related knee pain: a systematic review and qualitative analysis of clinical outcomes. Cardiovasc Intervent Radiol. 2021;44:1–9. https://doi.org/10.1007/s00270-020-02687-z.

    Article  PubMed  Google Scholar 

  15. Hirtler L, Lübbers A, Rath C. Vascular coverage of the anterior knee region – An anatomical study. J Anat. 2019;235:289–98. https://doi.org/10.1111/joa.13004.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barner KL, Mayer CM, Orth C, Tran QV, Olinger AB, Wright BW. Mapping the genicular arteries to provide a caution zone during knee surgery. Clin Anat. 2020;33:1049–55. https://doi.org/10.1002/ca.23535.

    Article  PubMed  Google Scholar 

  17. Elbarrany W, Altaf F. The tibial nerve and Its vasculature: an anatomical evaluation. Int J Morphol. 2017;35:812–9. https://doi.org/10.4067/S0717-95022017000300004.

    Article  Google Scholar 

  18. Chen C-H, Hsu M-Y, Jiang R-S, Wu S-H, Chen F-J, Liu S-A. Shrinkage of head and neck cancer specimens after formalin fixation. J Chin Med Assoc. 2012;75:109–13. https://doi.org/10.1016/j.jcma.2012.02.006.

    Article  PubMed  Google Scholar 

  19. Bagla S, Piechowiak R, Sajan A, Orlando J, Hipolito Canario AD, Isaacson A. Angiographic analysis of the anatomical variants in genicular artery embolization. J Clin Interv Radiol. 2021. https://doi.org/10.1055/s-0041-1729464.

    Article  Google Scholar 

  20. Petersen KK, Simonsen O, Laursen MB, Nielsen TA, Rasmussen S, Arendt-Nielsen L. Chronic postoperative pain after primary and revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2015;31:1–6. https://doi.org/10.1007/s001670050119.

    Article  Google Scholar 

  21. Arnoczky SP. Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res. 1983;172:19–25.

    Article  Google Scholar 

  22. Dubois G, Lopez R, Puwanarajah P, Noyelles L, Lauwers F. The corticoperiosteal medial femoral supracondylar flap: anatomical study for clinical evaluation in mandibular osteoradionecrosis. Surg Radiol Anat. 2010;32:971–7. https://doi.org/10.1007/s00276-010-0658-9.

    Article  PubMed  Google Scholar 

  23. Parvizi D, Vasilyeva A, Wurzer P, Tuca A, Lebo P, Winter R, et al. Anatomy of the vascularized lateral femoral condyle flap. Plast Reconstr Surg. 2016;137:1024e–32e. https://doi.org/10.1097/PRS.0000000000002182.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge Dr Kadar Allouni for facilitating academic collaboration.

Funding

The GENESIS study from which images and information are taken was funded by Merit Medical.

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Authors and Affiliations

  1. School of Medicine, Keele University, Keele, UK

    Aiden O’Grady & Luke Welsh

  2. University Department of Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK

    Matthew Gibson, James Briggs, Archie Speirs & Mark Little

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  1. Aiden O’Grady
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  2. Luke Welsh
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  3. Matthew Gibson
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Correspondence to Mark Little.

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Conflict of interest

MW Little is a paid consultant for Guerbet, Crannmed, Merit Medical, and Boston Scientific. None of the other authors declare a potential conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All training for this anatomical research project was carried out through Keele University’s School of Medicine Anatomical Facilities, under guidance of the HTA licence #12190 (Sect. 16; 2; c of the Human Tissue Act 2004). Prior to the project being conducted it was reviewed by the Anatomical Research Group (ARG) for its suitability to train an Anatomical Science student in scientific method, and subsequently scrutinised for any ethical concerns by the ARG Ethics (sub) Committee (including the HTA Licence Holder, the Facilities Manager, the project coordinator, and 2 representatives of ARG). The project was then detailed for review and documentation by the Keele University Human Tissue Committee.

Informed consent

Informed consent was obtained from all individual participants included in the GENESIS study.

Consent for publication

Consent for publication was obtained for every individual person’s data included in the GENESIS study.

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O’Grady, A., Welsh, L., Gibson, M. et al. Cadaveric and Angiographic Anatomical Considerations in the Genicular Arterial System: Implications for Genicular Artery Embolisation in Patients with Knee Osteoarthritis. Cardiovasc Intervent Radiol 45, 80–90 (2022). https://doi.org/10.1007/s00270-021-02978-z

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