Summary
Arthroscopic lateral retinacular release can be complicated by hemarthrosis in 10 to 18% of cases. The vascular structures involved are the lateral vascular pedicles of the knee. This study examines the topography of these pedicles. Anatomic and radioanatomic studies carried out in 50 specimens defined the route of the vascular pedicles at the lateral aspect of the knee. From the measurements carried out, we noted the relative homogeneity of the routes taken by the different proximo-lateral vascular pedicles, which are highly vulnerable, and the variability of the disto-lateral arterial routes. A tracing-paper study identified two distinct routes for the disto-lateral vascular pedicle and evaluated the risk of injury to it in surgical approaches to the lateral aspect of the knee. Finally, the topographic data of the study suggest the possibility of preventive hemostasis of the proximo-lateral pedicle via a minimal approach close to the patella. Furthermore, it seems possible to avoid cutting the disto-lateral pedicle if it is localised by cutaneous trans-illumination at the beginning of the operation.
Résumé
La section du rétinaculum patellaire latéral (aileron rotulien externe) par voie arthroscopique peut dans 10 à 18 % des cas se compliquer d'hémarthrose. Les structures vasculaires impliquées sont les pédicules vasculaires latéraux du genou. Ce travail étudie la topographie de ces pédicules. L'étude anatomique et radio-anatomique portant sur cinquante pièces précise le trajet des pédicules vasculaires de la face latérale du genou. Les mesures réalisées permettent d'affirmer la relative homogénéité des trajets des différents pédicules vasculaires proximo-latéraux, très vulnérables, et une variabilité de trajet des artères disto-latérales. La réalisation de calques permet d'identifier deux types de trajets distincts pour le pédicule vasculaire disto-latéral et d'apprécier le risque de le léser lors d'un abord de la face latérale du genou. Enfin, les données topographiques de l'étude permettent de discuter de l'opportunité d'une hémostase préventive du pédicule proximo-latéral par un abord minime à proximité de la patella. II semble possible, en outre, d'éviter de sectionner le pédicule disto-latéral grâce à sa localisation par trans-illumination cutanée en début d'intenvention.
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Vialle, R., Tanguy, J.Y., Cronier, P. et al. Anatomic and radioanatomic study of the lateral genicular arteries: application to prevention of postoperative hemarthrosis after arthroscopic lateral retinacular release. Surg Radiol Anat 21, 49–53 (1999). https://doi.org/10.1007/BF01635052
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DOI: https://doi.org/10.1007/BF01635052