The Anatomical Features Of Infrapatellar Fat Pad Vascular Network And Its Significance In TKA

BackgroundKnee is the most complicated and large weight-bearing joint of human body. With the development of aging society, the incidence rate of knee diseases, as osteoarthritis and traumatic arthritis, is ascending. It has seriously influenced the capability and living quality of the patients and brought a heavy burden to the society. According to statistics, 51% of senior people who are over 60 suffer osteoarthritis of the knee. The conservative treatments are less effective to severe lesions of the knee. Since Gunston designed an unrestricted total knee prosthesis in 1969,the technology of knee arthroplasty has developed dramatically and become a mature and most effective way against late osteoarthritis of the knee. At present, most large general hospitals in China are able to carry out total knee arthroplasty successfully, and the surgical techniques of surgeons become more and more sophisticated.How to reduce surgical trauma and postoperative complications is ever the supreme issue to our surgeons. Minimally invasive technology emerged based on and advanced and humanized concept of surgery. Compared with the conventional operative method, minimally invasive surgery can possibly reduce patients'trauma in a large scale not only physically but also psychologically. Nowadays, how to improve the effect of TKA and reduce the postoperative complications is still an important issue to our orthopedists.The infrapatellar fat pad, which is filling the wedge gap formed by patella, patellar ligament, femoral condyle, and anterior margin of tibial condyle, has a rich vascular network. It provides blood supplies to not only itself but also the neighboring structure such as the lower pole of patella and patellar ligament. Domestic and foreign literatures have few reports on infrapatellar fat pad , especially on the research of the anatomical features of infrapatellar fat pad vascular network and its great value to TKA. We observed the composition, direction, and distribution of the IFP's vascular network, and hoped to improve the accuracy of operation, reduce blood loss, protect nutrient vessels to patella and patellar ligament, and reduce corresponding complications through the careful anatomic observation, detailed understanding and analysis.ObjectiveThe purpose of this study is to provide an anatomic evidence of why and how to protect the blood supply of infrapatellar fat pad(IFP) in total knee arthroplasty(TKA).Mothods20 embalmed adult cadaveric knee and 2 fresh ones were undergone macro-micro-anatomy to observe the composition,route and distribution of their IFP vascular network.ResultThe lateral part of IFP vascular network was formed by inferior lateral genicular artery and the descending branches of superior lateral genicular artery, and the medial part of it was formed by the ascending branches of inferior medial genicular artery and the branches of descending genicular artery. All the arteries and branches connected to each other to build a"concentrated area"which ranged in 5mm to both side of patella, 14mm below the lower end of patella and 10mm behind PL and nourished the lower end of patella, the back of patellar ligament(PL) and the synovial membrane of of the whole IFP.ConclusionIFP is supposed to be reserved in TKA, because of its nourishing function, especially the"concentrated area".