Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Ahmad CS, Cohen ZA, Levine WN, Ateshian G, Mow VC (2001) Biomechanical and topographic considerations for autologous osteochondral grafting in the knee. Am J Sports Med 29(2):201–206
Al-Shaikh RA, Chou LB, Mann JA, Dreeben SM, Prieskorn D (2002) Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int 23(5):381–389
Ansah P, Vogt S, Ueblacker P, Martinek V, Woertler K, Imhoff AB (2007) Osteochondral transplantation to treat osteochondral lesions in the elbow. J Bone Joint Surg Am 89:2188–2194
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]
Del Piñal F, García-Bernal FJ, Delgado J, Sanmartín M, Regalo J (2005) Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient. J Hand Surg Am 30(6):1200–1210
Del Piñal F, García-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A (2007) Vascularized corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg Eur 32(2):135–142
Depreux R, Mestdagh H, Fontaine C, Moulleront S (1974) Vascularisation artérielle des condyles fémoraux. Lille chir 29(1):32–34
Doi K, Oda T, Soo-Heong T, Nanda V (2000) Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg 25A:507–519
Doi K, Sakai K (1994) Vascularized periosteal bone graft from the supracondylar region of the femur. Microsurgery 15(5):305–315
Garretson RB, Katolik LI, Verma N, Beck PR, Bach BR, Cole BJ (2004) Contact pressure at osteochondral donor sites in the patellofemoral joint. Am J Sports Med 32(4):967–974
Gautier E, Kolker D, Jakob RP (2002) Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br 84(2):237–244
Gelberman RH, Panagis JS, Taleisnik J (1983) The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg Am 8(4):375–382
Glowacki J (1998) Angiogenesis in fracture repair. Clin Orthop Relat Res 355S:S82–S89
Hangody L, Vásárhelyi G, Hangody LR, Sükösd Z, Tibay G, Bartha L, Bodó G (2008) Autologous osteochondral grafting-technique and long-term results. Injury 39S1:S32–S39
Huntley JS, Bush PG, McBirnie JM, Simpson AH, Hall AC (2005) Chondrocyte death associated with human femoral osteochondral harvest as performed for mosaicplasty. J Bone Joint Surg 87(2):351–360
Imhof H, Breitenseher M, Kainberger F, Rand T, Trattnig S (1999) Importance of subchondral bone to articular cartilage in health and disease. Top Magn Reson Imaging 10:180–192
Imhof H, Sulzbacher I, Grampp S, Czerny C, Youssefzadeh S, Kainberger F (2000) Subchondral bone and cartilage disease: a rediscovered functional unit. Invest Radiol 35:581–588
Iwasaki N, Kato H, Kamishima T, Suenaga N, Minami A (2007) Donor site evaluation after autologous osteochondral mosaicplasty for cartilaginous lesions of the elbow joint. Am J Sports Med 35(12):2096–2100
Jones DB Jr, Bürger H, Bishop AT, Shin AY (2008) Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts. J Bone Joint Surg Am 90(12):2616–2625
Judet R, Roy-Camille R, Guillamon JL (1972) Traitement de la pseudarthrose du scaphoïde carpien par le greffon pédiculé. Rev Chir Orthop Reparatrice Appar Mot 58(7):699–705
Kälicke T, Bürger H, Müller EJ (2008) A new vascularized cartilage-bone-graft for scaphoid nonunion with avascular necrosis of the proximal pole. Description of a new type of surgical procedure. Unfallchirurg 111(3):201–205
Kirschner MH, Menck J, Hennerbichler A, Gaber O, Hofmann GO (1998) Importance of arterial blood supply to the femur and tibia for transplantation of vascularized femoral diaphyses and knee joints. World J Surg 22:845–852
Kirschner MH, Menck J, Hofmann GO (1996) Anatomic bases of a vascularized allogeneic joint transplantation: arterial blood supply of the human knee joint. Surg Radiol Anat 18:263–269
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):203–210
Larson AN, Bishop AT, Shin AY (2007) Free medial femoral condyle bone grafting for scaphoid nonunions with humpback deformity and proximal pole avascular necrosis. Tech Hand Up Extrem Surg 11(4):246–258
Lyons TJ, McClure SF, Stoddart RW, McClure J (2006) The normal human chondro-osseous junctional region: evidence for contact of uncalcified cartilage with subchondral bone and marrow spaces. BMC Musculoskelet Disord 7:52
Malinin T, Ouellette EA (2000) Articular cartilage nutrition is mediated by subchondral bone: a long-term autograft study in baboons. Osteoarthr Cartil 8:483–491
Masquelet AC, Romana MC, Penteado CV (1989) Vascularized periosteal grafts. In: Aebi M, Regazzoni P (eds) Bone transplantation. Springer, Berlin, pp 259–269
Oakeshott RD, Farine I, Pritzker KPH, Langer F, Gross AE (1988) A clinical and histologic analysis of failed fresh osteochondral allografts. Clin Orthop Relat Res 233:283–294
Peña E, Calvo B, Martínez MA, Palanca D, Doblaré M (2005) Finite elements analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics. Clin Biomech 20:498–507
Penteado CV, Masquelet AC, Romana MC, Chevrel JP (1990) Periosteal flaps: anatomical bases of sites of elevation. Surg Radiol Anat 12(1):3–7
Pinskerova V, Iwaki H, Freeman MAR (2000) The shapes and relative movements of the femur and tibia at the knee. Orthopäde 29:S3–S5
Reddy AS, Frederick RW (1998) Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med 26(3):415–419
Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E (2007) The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med 35(1):80–85
Rogers WM, Gladstone H (1950) Vascular foramina and arterial supply of the distal end of the femur. J Bone Joint Surg 32(4):867–874
Rothenfluh DA, Demhartner TJ, Fraitzl CR, Cecchini MG, Ganz R, Leunig M (2004) Potential role of pre-existing blood vessels for vascularization and mineralization of osteochondral grafts. Acta Orthop Scand 75(3):359–365
Sakai K, Doi K, Kawai S (1991) Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 87(2):290–298
Salon A, Hémon C (2003) Conservative surgery in Kiënbock’s disease with perilunate arthrosis: articular resurfacing using resected carpal bones. Chir Main 22(3):154–157
Shasha N, Aubin PP, Cheah HK, Davis AM, Agnidis Z, Gross AE (2002) Long-term clinical experience with fresh osteochondral allografts for articular knee defects in high demand patients. Cell Tissue Banking 3:175–182
Sheetz KK, Bishop AT, Berger RA (1995) The arterial blood supply of the distal radius and ulna and its potential use in vascularized pedicled bone grafts. J Hand Surg Am 20:902–914
Shim SS, Leung G (1986) Blood supply of the knee joint. A microangiographic study in children and adults. Clin Orthop Relat Res 208:119–125
Steinmann SP, Bishop AT, Berger RA (2002) Use of the 1, 2 intercompartmental supraretinacular artery as a vascularized pedicle bone graft for difficult scaphoid nonunion. J Hand Surg Am 27A:391–401
Tanaka Y, Omokawa S, Fujii T, Kumai T, Sugimoto K, Takakura Y (2006) Vascularized bone graft from the medial calcaneus for treatment of large osteochondral lesions of the medial talus. Foot Ankle Int 27(12):1143–1147
Tang P, Imbriglia JE (2007) Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy. J Hand Surg Am 32(9):1334–1342
Taylor GI, Miller GDH, Ham FJ (1975) The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 55:533–544
Thaunat M, Couchon S, Lunn J, Charrois O, Fallet L, Beaufils P (2007) Cartilage thickness matching of selected donor and recipient sites for osteochondral autografting of the median femoral condyle. Knee Surg Sports Traumatol Arthrosc 15:381–386
Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 61(1):56–62
Williams SK, Amiel D, Ball ST, Allen RT, Tontz WL et al (2007) Analysis of cartilage tissue on a cellular level in fresh osteochondral allograft retrievals. Am J Sports Med 35(12):2022–2032
Acknowledgments
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).
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Hugon, S., Koninckx, A. & Barbier, O. Vascularized osteochondral graft from the medial femoral trochlea: anatomical study and clinical perspectives. Surg Radiol Anat 32, 817–825 (2010). https://doi.org/10.1007/s00276-010-0629-1
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DOI: https://doi.org/10.1007/s00276-010-0629-1