Intraoperative anatomy of the vascular supply to the medial femoral condyle

The arterial anatomy of the medial femoral condyle (MFC) for vascularized bone grafting has been extensively studied in cadaveric specimens. A majority of cadaveric studies have limited numbers of specimens, and the data from these studies are extrapolated to the surgical environment. The purpose of this study is to evaluate the vascular anatomy of the medial femoral condyle in a large clinical series. A retrospective review of operative reports was conducted of medial femoral condyle and trochlea vascularized bone grafts performed by the senior surgeons between 2005 and 2018. A total of 113 patients were included in the study. Demographic data, preoperative diagnosis, and type of graft harvested were collected. The descending genicular artery, a branch of the superficial femoral artery, was the dominant pedicle in 77% of cases. It was also the dominant arterial pedicle for medial femoral trochlea (MFT) bone grafts in 7 out of the 9 cases (77.8%). The superomedial genicular artery was the dominant pedicle in 23% (26 of 113 total) of all cases. In eight patients, a descending genicular branch was not identified. The superomedial genicular artery was absent in 2% of cases (2 of 113). The descending genicular artery was the dominant arterial pedicle for vascularized bone grafts from the medial femur and was present in 93% of cases. This is in contrast to published cadaveric studies showing the artery was present in 89% of specimens.