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Blood Supply to the Knee

- Discussion:
    - blood supply to skin around the knee is random (as opposed to axial)
    - there are multiple small overlapping vessels that are interrupted by multiple small incisions;
    - random supply is sustained by both intrinsic and extrinsic sources;
         - intrinsic contributors to skin overlying knee are perforationg branches of the superior and inferior genicular systems;
    - extrinsic supply: 3 sources;
         - descending genicular (supreme genicular artery) branch of superficial femoral artery
                - arises superomedial to the knee from SFA;
                - after sending saphenous branch inferiorly, SGA heads into VM and sends perforators to overlying skin thru musculocutaneous insertion of VM into patella;
         - recurrent branch of anterior tibial artery;
              - emerges from anterior tibial artery as it perforates interosseous foramen;
              - this branch passes superiorly and in the direction of patellar tendon, supplying the skin overlying patellar tendon;
         - descending branch of the lateral femoral circumflex artery;
              - one of the major communications between deep and superficial femoral systems of the leg;
              - it travels down fascia lata & sends multiple perforators to skin overlying fascia lata & lateral aspect of knee;

- Anatomy: 
      - middle genicular
            - arises approximately at the level of the joint line and passes anteriorly to pierce the oblique popliteal ligament and posterior joint capsule;
            - traverses the posterior joint capsule at level of intercondylar notch;
            - supplies the ACL and PCL 
            - references:
                    - Anatomic study of the middle genicular artery.
                    - Vascular anatomy of the human cruciate ligaments and surrounding structures.
    - medial superior genicular
         - lies anterior to the semimembranous & semitendinosus muscles; 
    - medial inferior genicular
         - passes underneath origin of gastrocnemius, located at the superior surface of the popliteus muscle and passes around medial aspect of proximal tibia, 
                 passes deep to the superficial MCL to reach front of knee, 2 cm distal to joint;
         - anastomosis w/ the saphenous branch of the descending genicular branch;
         - anastomosis w/ anterior tibial recurrent 
         - references:
                - Arteriovenous fistula with false aneurysm of the inferior medial geniculate artery. A complication of total knee arthroplasty
                - Traumatic aneurysm of the inferior lateral geniculate artery after total knee replacement
    - lateral superior genicular 
         - anastomosis w/ the descending branch of LCFA;
         - references:
                - Therapeutic embolization for the treatment of recurrent hemarthrosis after total knee arthroplasty due to an arteriovenous fistula
                - False aneurysm of the superior lateral geniculate artery following total knee replacement

    - lateral inferior genicular
         - anastomosis w/ anterior tibial recurrent artery;
         - passes underneath origin of gastrocnemius to reach front of knee
         - passes deep to lateral collateral ligament at level of the joint (passing superficial to the popliteus tendon);
         - passes over the lateral limb of the arcuate ligament and popliteal musculotendinous junction and the lateral meniscus; 
         - references:
                - Recurrent hemarthrosis after total knee arthroplasty
                - Persistent haemarthrosis following total knee arthroplasty caused by unrecognised arterial injury
    - descending branch of lateral circumflex femoral; 
    - descending genicular branch of the femoral artery;
    - recurrent vessels:
            - anterior tibial 
                   - ref: Atraumatic haemarthrosis following total knee replacement treated with selective embolisation.
            - posterior tibial  (posterior tibial recurrent)
            - circumflex fibular - (anterior tibial recurrent) 

Clinical, roentgenographic, and scintigraphic results after interruption of the superior lateral genicular artery during total knee arthroplasty.

Blood supply of the knee joint. A microangiographic study in children and adults.   

Surgical interruption of patellar blood supply by total knee arthroplasty.