Quantitative and Qualitative Assessment of Bone Perfusion and Arterial Contributions in a Patellar Fracture Model Using Gadolinium-Enhanced Magnetic Resonance Imaging
A Cadaveric Study
Lionel E. Lazaro, MD; David S. Wellman, MD; Craig E. Klinger, BS; Jonathan P. Dyke, PhD; Nadine C. Pardee, BA; Peter K. Sculco, MD; Marschall B. Berkes, MD; David L. Helfet, MD; Dean G. Lorich, MD

Abstract

Background: The purpose of the present study was to evaluate the anatomy and contribution of the patellar vascular supply and to quantify the effect of a transverse fracture on patellar perfusion.

Methods: In twenty matched pairs of fresh-frozen cadaveric knees, the superficial femoral artery, anterior tibialis artery, and posterior tibialis artery were cannulated. One side of each matched pair was randomly selected to undergo one of two osteotomies: (1) midpatellar osteotomy or (2) distal-pole osteotomy. For volumetric analysis, comparisons were performed between contrast-enhanced magnetic resonance images and precontrast magnetic resonance images as well as between osteotomized patellar bone fragments and the corresponding intact areas on the control side. We then injected a urethane polymer compound and dissected all specimens to examine extraosseous vascularity.

Results: Magnetic resonance imaging demonstrated that the largest arterial contribution to the patella entered at the inferior pole in 100% of the specimens; in 80% of these specimens, the artery entered inferomedially. It also revealed an overall decrease in contrast enhancement in both transverse osteotomy groups, with an average reduction in enhancement in the proximal fragment of 36%.

Conclusions: If possible, surgical interventions about the knee should be carefully planned to preserve the peripatellar ring (the source of the entire patellar blood supply), especially the inferior patellar network. Distal-pole patellectomy should be avoided to retain vascularized bone at the reduced fracture site.

Footnotes

  • Investigation performed at the Hospital for Special Surgery, New York, NY

  • Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.


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