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The arterial supply and venous drainage of the bones of the human knee joint.

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The Arterial Supply and Venous Drainage of the Bones
of the Human Knee Joint’
HENRY V. CROCK
Anatomy Department, University of Melbourne and St. Vincent’s Hospital,
Melbourne, Australia
ABSTRACT
This paper is based on a study of bones from fifty-five (55) knee joints,
ages ranging from newborn to ninety (90) years. Full details of techniques of s p e d
men injection and preparation are given.
The gross arterial and venous patterns in adult bones are identical with the
patterns present within these structures which are largely cartilaginous at birth.
The lower end of the femur is penetrated by radiate epiphyseal arteries around
its circumference. These terminate i n sinusoidal capillaries within the cartilage, the
corresponding veins leaving along the lines of entry of the radiate arteries. NO
anastomoses exist between adjacent intracartilaginous vessels, their distribution in the
epiphysis being segmental. The lateral superior genicular radiate epiphyseal arteries,
for example, supply a relatively fixed segment of the lateral femoral condyle. This
arrangement no longer exists when the ossific center extends to involve the sinusoidal
tips of more and more vessels, effective anastomoses eventually developing between
all vessels supplying the lower end of the femur.
Analagous findings are reported in the tibia.
The patella is penetrated at its center and lower pole by nutrient arteries.
In adult bones a subarticular collecting vein system is orientated parallel to
articular surfaces. Short venous stems of subchondral capillary loops drain into these
subarticular collecting veins which then drain off at articular margins into tributaries
of the main veins. These are original findings.
With the evolution of technical aids for
research there has been a tendency for
investigators to devote less attention to
some of the problems of anatomy which
remain to be further clarified by the use
of quite simple techniques. This applies
particularly to the study of intraosseous
vascular patterns. Although interest in
this subject was first seriously stimulated
and knowledge of it advanced by the work
of Lexer and his colleagues (’04), little
is known and Iittle is taught of the subject today. Orthopedic surgeons have recognized the practical importance of a
knowledge of the blood supply of bones
and indeed some of them have contributed
to the study of the subject. On the other
hand, relatively few anatomists have applied themselves to studies in this particular field in recent years. Most papers dealing with this general subject treat of
limited aspects of vascular anatomy in
one part of a particular bone (Kelly et al.
’61). It is difficult to find information on
both the arteries and veins within bones
in one article. In fact, even in some recent
publications the authors fail to distinguish
between arteries and veins in their specimens (Haliburton et al., ’58).
This paper deals with the arterial supply
and venous drainage of the lower end of
the femur, the patelIa and the upper end
of the tibia in man. A critical appreciation
of the methods used in this investigation
is included. By presenting the vascular
anatomy of the bones of the knee joint
in one article certain well known anatomical features are thereby highlighted and
new findings on the arrangement of veins
in subchondral areas are shown to advantage.
MATERIALS AND METHODS
The specimens were obtained at postmortem examinations from 55 subjects of
varying ages, ranging from newborn infants to adults of 90 years. A barium
sulphate suspension (Micropaque) , mixed
with water or colored with Prussian Blue,
was injected into the femoral arteries or
]The illustrations for this paper were prepared
from bones injected at St. Vincent’s Hospital and the
Royal Children’s Hospital, Melbourne. Financial
assistance for the reproduction of the illustrations
was obtained from St. Vincent’s Hospital. Melbourne.
199
200
HENRY V. CROCK
into the saphenous veins. The main vessels of the limbs were cleared of postmortem clots before the micropaque injections were performed. The arterial trees
were flushed out with water through small
cannulae inserted into the posterior tibia1
arteries at ankle level, micropaque being
then injected from groin level downwards
through 3 mm bore polythene tubing inserted into the femoral arteries. In the
case of venous injections, the cannulae
were inserted into the long saphenous
veins over the medial malleoli, and the
veins were cleared of clots. Tourniquets
were then placed at midthigh level and
the micropaque was injected through the
cannulae.
A11 the injections were carried out with
a special pump, a modified version of an
oxygen driven blood infusion pump (Salt
et al., '61). The apparatus provided a constant but variable pressure source. Injec.
tion pressures for arterial specimens vaned
between 2 and 7 lbs. to the square inch,
increasing with the age of the subject.
Injection pressures of between 12 and
15 lbs. to the square inch were used for
venous injections. The volume of micropaque injected into a lower limb varied
considerably with the size of the patient
and the area of the limb open to the
injection mass. In infants, volumes of micropaque as low as 40 cm3provided excellent filling of the vessels, while in adults
between 750 cma and 1,800 cm3 of micropaque were required. Workers familiar
with injection techniques agree that the
results obtained in any particular case are
largely unpredictable. From the experience
gained in the preparation of the present
work and in line with that of certain other
workers (Norberg personal communication,
'60) it would seem that a constant pressure
source coupled with an adequate flow time
of up to 45 minutes, helps to provide optimum conditions for obtaining good injections of intraosseous vessels. Furthermore, the use of a tourniquet at midthigh
level seems to be essential in the process
of performing successful intraosseous venous injections as described in this paper.
Following the injection of micropaque,
th,e bones were removed and fixed in 10%
formalin over the course of five to seven
days. The specimens were then stripped
of all overlying soft tissues, unless details
of the surface vessels were required for
study, and the process of decalcification in
10% nitric acid commenced. In some
cases the bones were cut into sections
before decalcification. The progress of the
decalcification of the bones was followed
carefully by repeated radiographs and
when it was completed, the specimens
were sectioned in various planes so that
the intraosseous vascular patterns could
be studied in perspective. For ordinary
purposes the ends of the long bones were
cut into slices ranging from 1 to 2.5 cms
in thickness.
The specimens thus obtained were then
cleared by the well known Spalteholz
method, ('11). In addition a number of
specimens were embedded in ceIIoidin and
histological sections were cut at 40 LI and
at 400
and stained with hematoxylin
and eosin.
Illustrations were prepared either from
radiographs of the decalcified bones or
from photographs of the cleared specimens. It is important to note that certain
features of the venous drainage in subchondral areas can only be shown to advantage by photographing the cleared specimens in solution with light directed on
to the cartilaginous surfaces, whereas if
the same specimens are photographed with
light transmitted through their whole
thickness, these particular features are
overshadowed by the outlines of larger
veins deeper in the bones.
A further point of technique of great
value was noted in specimens in which
the arteries had been injected through a
large vessel in the limb, with a tourniquet
applied above the site of the cannula. In
such cases micropaque filled the intraosseous arteries and their small branches,
while the intraosseous veins became engorged with blood. When these specimens
were cleared by the Spalteholz technique,
they demonstrated the exact relationships
of arteries and veins within the bones.
Combining photographic and radiographic
methods, the visual evidence of these relationships could be easily recorded.
H U M A N KNEE JOINT INTRAOSSEOUS VESSELS
THE ARTERIES OF THE LOWER
END OF THE FEMUR
The medial and lateral condyles are
each covered with a network of arteries
of small caliber which are branches of the
superior medial and lateral genicular arteries. These genicular arteries have their
origins from the popliteal artery at varying
levels, but their fanlike patterns of distribution over the femoral condyles are remarkably constant, (Rogers and Gladstone,
'SO). Branches from the superior medial
and lateral genicular arteries spread out
over the anterior aspect of the lower end
of the femur where they are joined by
branches of the descending genicular artery and where they anastomose with periosteal branches of the perforating arteries.
From these arteries which are closely applied to the medial, anterior and lateral
surfaces of the lower end of the femur
spring the intraosseous branches about to
be described. The posterior aspect of the
lower end of the femur receives its
intraosseous arteries predominantly from
branches of the middle genicular artery.
The intraosseous distribution of arteries
and veins in the lower end of the femur
can be adequately studied in transverse
and coronal plane sections. At birth the
small secondary center of ossification for
20 1
the lower end of the femur occupies a
position which is roughly in the center of
the epiphysis. If this lower femoral epiphysis is cut into two transverse sections of
approximately equal thickness, the distal
section will be entirely cartilaginous, and
the proximal section will contain the ossific center (figs. l a , b, 6 and 7). For
descriptive purposes, it is easier to begin
by outlining the vessel arrangements in
the distal transverse section (fig. 7). The
lower femoral epiphysis at birth is penetrated around its circumference by a series
of radially disposed arteries which enter
the epiphysis along canals visible to the
naked eye. If the quality of the injection
has been good, in certain of these canals,
veins will be found partially filled, in company with their parent arteries (fig. 7).
Those arteries entering the medial, anterior and lateral faces form a coronet of
regularly spaced vessels which terminate
within the cartilage of the epiphysis in
sinusoidal capillaries. Those which enter
the intercondylar zone posteriorly fan out,
terminating also in capillary beds of this
particular type (figs. 6 and 7). It is to be
noted that there are no anastomoses between these vessels within the substance
of the epiphysis. However where the bone
of the ossific center is developing there is
Fig. 1 The lower end of the femur viewed from in front, showing the levels of two
transverse sections. The outlines of the two specimens thus obtained are shown on the
right (a, b ) (see figs. 6-10).
202
HENRY V. CROCK
a profusion of vessels and the first anastomoses are formed in it between arteries
entering from different surfaces of the epiphysis. The significance of this anatomical
arrangement will be referred to in the
discussion.
With the extension of ossification in the
lower end of the femur, certain changes
occur in the intraosseous arteries. The
main stems of entrant arteries stand out
clearly as in the newborn, but anastomoses
develop between them, through branches
of wide caliber. These anastomoses become outstanding features of the arterial
arrangements in the body of the epiphysis
during growth. In the subarticular zones
the arterial network becomes very dense
and is arranged in closely packed delicately arching loops. A further feature of
the arterial pattern in this area is seen in
the penetrating vascular tufts, based on
quite large arterial branches, which push
ahead of the subarticular loops. It is around
these tufts that ossification occurs extending the growth of the bony epiphysis
(Crock, '62).
When the growth plate of the distal
femoral epiphysis is established no vessels
cross it to enter the metaphysis, although
there are many extraosseous anastomoses
between epiphyseal and metaphyseal arteries. With the closure of the epiphyseal
plate, there is a free anastomosis established between metaphyseal and epiphyseal
vessels.
In the adult, radiate arteries penetrate
the lower end of the femur, their pattern
of distribution resembling closely the basic
arrangements already described in the epiphysis at birth (fig. 8) and in the subchondral zones terminal arteries give rise
to the capillary loops which nourish the
deeper cells of the articular cartilage.
intraosseous arteries and veins are clearly
seen when corresponding injected sections
are examined side by side (figs. 8 , 9). The
radiate veins are of wider caliber than
their corresponding arteries, while their
main tributaries have wavy outlines.
In coronal or sagittal sections fine veins
in the subarticular zone drain away towards the center of the lower end of the
femur, increasing in caliber until they
form easily recognized tributaries of the
radiate veins. When examining sections
in these planes, in addition to the veins
which appear to drop away from the subarticular areas at right angles, one finds
veins, easily visible to the naked eye in
cleared specimens, which are orientated
parallel to the surface of the articular cartilage lying close to its bony attachment.
This system of veins is best studied in a
cleared specimen of a distal transverse
section of the lower end of the femur. It
is difficult to obtain a specimen in which
this beautiful complex system of veins is
completely Med. The specimen illustrated
in figure 10 has been photographed in
Spalteholz fluid, the light source being
directed at the articular surface so that
the subarticular veins alone stand out.
These subarticular collecting veins are
orientated transversely across the lower
end of the femur. They drain off around
the margins of the joint cartilage where
ultimately they merge into tributaries
which join the radiate veins as they pass
out on to the surface of the lower end of
the femur.
THE ARTERIES AND VEINS
OF THE PATELLA
The anterior surface of the patella is
covered with an arterial network derived
mainly from branches of the genicular
arteries. Although this prepatellar arterial
THE VENOUS DRAINAGE OF THE
plexus appears complex in dissected speciLOWER END O F THE FEMUR
mens, or in cleared specimens, such as
Reference has already been made to the that illustrated in figure 11, the intrarelationship between entrant arteries and osseous branches derived from it are conemerging veins in the lower femoral epi- stant in their distribution within the bone.
physis at birth, (fig. 7) (Nelson et al., The arteries supplying the patella enter
'60). In the lower end of the adult femur, about its center and at its lower pole on the
the main draining veins are disposed deep surface.
radially in patterns which mirror those
The patella at birth is entirely cartilagiseen in arterial injections (fig. 9) but dis- nous, yet its arterial supply is already
tinctive differences in appearance between established in the pattern described above
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
a
Fig. 2 The patella viewed from in front, showthe site of a sagittal section, the outline of the
specimen thus obtained being drawn alongside
( a ) (see figs. 11-16).
203
stem veins emerging from the body of the
patella.
The exact location of this system of
veins can be accurately described only
after examining histological sections such
as the one illustrated in the adjacent figure 14. What appears to be a subchondral
vein in the radiograph, can be clearly seen
to be a subarticular vein, separated by a
bony trabecula from the articular cartilage.
The detailed relationships of the subarticular collecting veins to subchondral capillaries become apparent at higher magnifications when the calcified zone of the
articular cartilage can be seen resting on
a bony plate, which is perforated by fine
channels at regular intervals ( f i g s . 15, 16).
Through these channels pass the terminal
arterial branches which form capillaries,
the venous limbs of which pass downwards
to drain directly into the subarticular collecting veins (fig. 17).
THE ARTERIES AND VEINS OF THE
UPPER END OF THE TIBIA
The intraosseous arterial supply of the
upper end of the tibia resembles closely
the pattern described in the lower end of
Fig. 3 A drawing of a sagittal section taken
from the patella represented in figure 2. The site the femur (Nelson et al., '60). In transof a transverse section from this specimen is verse sections radiate arteries enter around
marked out and the outline of the thin section its whole circumference (fig. 18) and as
thus obtained is shown on the right ( a ) (see
in the femur and patella this pattern is
fig. 17).
already established at birth.
Numbers of arteries enter the intercon(fig. 12). In the adult bone, the same
basic pattern of intraosseous arterial dis- dylar area and descend into the respective
tibial plateaux, so that, in effect, each
tribu tion persists.
plateau
has a circumferential radiate
The main venous channels follow the
arterial supply (figs. 20, 21). Detailed
paths taken by the main arteries of supply, descriptions of arterial terminations and
with the very notable exception that there anastomoses will not be given here. A
exists a subarticular venous drainage sys- concise account of these matters has
stem, analagous to that already described been given in the section dealing with
in the femur and to an identical system in the lower end of the femur and there are
the tibia which will be described below.
no significant variations between the two
In figure 13 a subarticular vein is seen bones at this level of their vascular anatin a radiograph of a central sagittal sec- omy.
tion of a patella. The gross features are
During growth, the upper tibial epithose of a prominent vein (or veins) of physeal plate forms a barrier between
rather wavy outline, situated parallel to the intraosseous metaphyseal and epiphyseal
articular surface and lying in a subchon- vessels (figs. 20, 21). Once again it should
dral situation. These veins are draining be stressed that this does not mean that
to the inferior pole of the patella, passing there is a total independence of blood
forwards along the inferior cortex at the supply in the epiphysis and metaphysis.
inferior articular margin, to join main When cleared specimens are examined in
204
HENRY V. CROCK
a
a
b
Fig. 4 The upper end of the tibia viewed from in front showing the level of a transverse section. The outline of the specimen thus obtained is shown on the right ( a ) (see
figs. 18, 19).
Fig. 5 The upper end of the tibia viewed from in front showing the sites of two sagittal sections with the outlines of the specimens thus obtained drawn alongside ( a , b ) (see
figs. 20, 21).
detail, the extraosseous plexus from which
the intraosseous arteries arise can be seen
to give off many branches which bifurcate,
one limb entering the epiphysis and the
other descending into the metaphysis.
The main veins of the upper end of
the tibia follow the course of the radiate
arteries. The subarticular collecting veins
are orientated in sweeping, wavy, parallel
lines, which run anteroposteriorly. This
venous network follows the contours of the
tibial condyles and drains off at the articular margins into tributaries which join the
emerging radiate veins (fig. 19).
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
DISCUSSION
The techniques used in the preparation
and study of intraosseous vessels are simpie, yet their proper application is of singular importance. In this paper a serious
attempt has been made to give detailed
information about methods because many
authors pass lightly over these matters,
dismissing them with few words (Harris
and Jones, '56). Several important points
about the actual method of injection have
been raised. Adequate injections of intraosseous vessels can only be made in the
intact body or into the major vessels of
amputated limbs.. It is virtually useless to
attempt to inject intraosseous vessels for
detailed studies by trephining the bones or
by placing cannulae directly into nutrient
arteries (Tilling, '58). The flushing out
of intravascular clots seems worthwhile
provided it is done by the method described, a method similar to that used now
by vascular surgeons when they are attempting to reestablish blood flow in the
smaller caliber arteries of the limbs. Good
arterial injections can be obtained using
the method described by Trueta and Harrison ('53); however, the use of an injection
apparatus is to be recommended because
of its convenience and because it provides
a constant but controlled pressure source
for the necessary conditions of prolonged
injection time at high pressure, for the
intraosseous venous injections in particu-
lar.
Undoubtedly the most valuable single
technique in studies of this kind is the
Spalteholz clearing method ('1 1 ). Attention has been drawn in the text to the
importance of the placing of light sources
when photographing specimens cleared by
this method. It is necessary to combine the
evidence from sections in different planes
examined by x-ray, by photography as described and by special histological techniques. in order to build up a clear concept
of the distribution of blood vessels within
bones. Too much reliance cannot be placed
on interpretations based on the use of one
of these methods alone, as each has its
limitations.
In the study of the arterial supply of the
lower end of the femur at birth the striking
feature which emerges is the segmental
205
nature of the distribution of vessels within
the epiphysis. At the stage of growth of
the femur when there are virtually no
anastomoses between the intraepiphyseal
arteries derived from different extraosseous sources (figs. 6,7), segmental lesions
may develop within the lower femoral epiphysis. If the intraepiphyseal vessels
which are based on the lateral superior
genicular artery, for example, were to be
seeded with destructive organisms, then a
segmental condylar defect would ensue.
Such a condition is known to affect the
lower femora1 and upper tibial epiphyses
but clinicians are not familiar with the
anatomical basis of this localization, although they suspect it (Lloyd-Roberts,'60).
PoweIl (personal communication, '60) has
attempted to focus attention on this matter, but his observations have not been published. The same segmental distribution
of vessels is found in the upper tibial epiphysis at birth, but this has not been illustrated in the present paper. Vessels have
been shown to enter and to leave around
the whole of the circumference of the
lower end of the femur and the upper end
of the tibia. Their gross pattern of distribution is a radiate one already established at birth and not varying, except in
certain detailed arrangements, throughout
life. Evidently, there is some practical
significance in the segmental arrangements of the intraepiphyseal vessels at
least in early life.
There appears to be no firmly established nomenclature for the intraosseous
vessels of the bones of the human knee
joint, standard anatomical texts making
no mention of their existence (Rogers and
Gladstone, '50). On the basis of the observations made in this paper a simple
nomenclature for the vessels within these
two bones is suggested.
NOMENCLATURE OF THE ARTERIES AND
VEINS OF THE LOWER END OF
THE FEMUR
THE RADIATE EPIF'HYSEAL ARTERIES OR
VEINS OF THE LOWER END OF
THE FEMUR
(At birth and during growth)
These may be described in further detail as required: for example, one may
refer to the superior lateral genicular radiate epiphyseal arteries.
206
HENRY V. CROCK
THE RADIATE ARTERIES OR VEINS OF
THE LOWER END O F THE FEMUR
( I n the adult)
Again, if necessary, further elaboration
of description may be accomphhed by
adding standard descriptive phrases; for
example: anterior radiate arteries or veins
of the lower end of the femur or medial
condylar radiate arteries or veins of the
lower end of the femur.
NOMENCLATURE OF THE ARTERIES AND
VEINS OF THE UPPER END
OF THE TIBIA
THE RADIATE EPIPHYSEAL ARTERIES
OR VEINS OF THE UPPER END
OF THE TIBIA
(At birth and during growth)
THE INTERCONDYLAR RADIATE EPIPHYSEAL
ARTERIES OR VEINS OF THE UPPER
END OF THE TIBIA
(At birth and during growth)
As in the case of the lower femoral epiphysis, further descriptive detail might be
required in the upper end of the tibia, an
example of which could be: the inferior
medial genicular radiate epiphyseal arteries or veins of the upper tibia1 epiphysis.
THE RADIATE ARTERIES OR VEINS
OF THE UPPER END OF
THE TIBIA
(In the adult)
THE INTERCONDYLAR RADIATE ARTERIES
OR VEINS O F THE UPPER END
O F THE TIBIA
( I n the adult)
THE SUBARTICULAR COLLECTING VEINS
The most significant finding reported
in this paper is the Subarticular Collecting
Vein System. Subarticular collecting veins
have been demonstrated in each of the
bones of the knee joint. They exist evidently only in adult bones and probably
appear when the articular cartilages are
finally formed with the establishement of
their calcified zones. The nourishment of
the deepest layers of articular cartilage is
apparently based on the exudation of tissue fluid from subchondral capillary loops,
the short venous stems of which have been
shown, in this present work, to drain directly into the subarticular collecting veins
(Barnett et al., '61).
To the author's knowledge this system
of veins has not been described previously,
although a considerable volume of work
on the venous circulation in human limb
bones has been reported from Russia
(Vsevolodov, '59).
ACKNOWLEDGMENTS
I wish to thank Professor L. J. Ray for
his help and advice, Mother Alphonsus for
financial assistance and Dr. M. C . Shorten
for useful criticism. I am grateful to the
following for their technical help: J.
Skehan, B. Winter, Miss N. Carroll (histology), L. Van der Velk, A. Daniel, E.
Moir (photography), A. Strohlein (drawings), Miss M. Shorten and Mrs. E. R.
Dingwall (typing).
LITERATURE CITED
Barnett, C. H., D. V. Davies and M. A. MacConaill 1961 Synovial joints - their structure and mechanics. Longmans, Green and
Co. Ltd., London, 89-104.
Crock, H. V. 1962 The scope and importance
of orthopaedic management of haemophiliacs.
Anz. J. S. 31: 189-200.
Haliburton, R. A., C. R. Sullivan, P. J. Kelly and
L. F. A. Peterson 1958 The extraosseous and
intraosseous blood supply of the talus. J. B. J. S.,
40A: 1115-1120.
Harris, R. S., and D, M. Jones 1956 The arterial supply to the adult cervical vertebra1 bodies. J. B. J. s., 38B: 922-927.
Kelly, P. J., G. E. Nelson, L. F. A. Peterson and
A. H. Bulbulian 1961 The blood supply of
the tibia. The Surg. Clin. N. Amer., 41 (6):
1463-1471.
Lexer, E., P. Kuliga and W. Turk 1904 Untersuchungen uber Knochenarterien mittelst. Rontgenaufnahmen injiziester Knochen und irhe
Bedeutung fur einzelne pathologische vorgange
a m Knochensysteme. Berlin A. Hirschwald.
Lloyd-Roberts, G. C. 1960 Suppurative arthritis
of infancy. J. B. J. S., 42B: 706-720.
Nelson, G. E., P. J. Kelly, L. F. A. Peterson and
J. M. Janes 1960 Blood supply of the hum a n tibia. J. B. J. S.,42A: 625-636.
Norberg, I. 1960 Personal communication.
Powell, H. D. 1960 Personal communication.
Rogers, W. M.,and H. Gladstone 1960 Vascular foramina and arterial supply of the distal
end of the femur. J. B. J. S., 32A : 867-874.
Salt, R. H., M. R. P. Hall and W.H. Taylor 1961
An oxygen driven blood infusion pump. Lancet
1, 642-644.
Spalteholz, K. W. 1911 Ueber das Durchsichtigmachen von menschlichen und tierischen
H U M A N KNEE JOINT INTRAOSSEOUS VESSELS
-
Pramraten: nebst Anhane: Ueber Knochenfarbung Leipzig, S. Hirzel.
Tilling, G. 1958 The vascular anatomy of long
bones. Acta Radiologica Supplementurn, 161:
1-107.
207
Trueta, J., and M. H. M. Harrison 1953 The
normal ;ascular anatomy of the femoral head
in adult man. J. B. J. S., 35B: 4 4 2 4 6 1 .
Vsevolodov, G. F. 1959 Veins of compact substance of lone: tubular bones of the extremities
in man. Arkh. Anat., 37: 60-65.
PLATE 1
EXPLANATION O F FIGURES
208
6
A photograph of a proximal transverse section from the lower end
of a right femur of a five day old female child, arterial injection.
Spalteholz cleared specimen, x 1% approx. The superior medial,
anterior and lateral genicular radiate epiphyseal arteries can be
seen terminating i n sinusoidal capillaries within the cartilage of the
epiphysis. The secondary center of ossification stands out clearly as
a white ball. Anastomoses occur around and within it, between
intercondylar and anterosuperior genicular radiate epiphyseal arteries. Elsewhere in the epiphysis at this stage of growth the arteries
are end arteries with a functionally segmental distribution in the
epiphysis.
7
A photograph of a distal transverse section from the lower end of
the femur illustrated in figure 6, arterial injection. The radiate pattern of distribution of the intercondylar arteries is seen. The central
vessel in this group appears thicker than its companions and its
terminations are more bulbous. This is due to venous filling which
has been almost complete i n this case.
8
A photograph of a proximal transverse section from the lower end
of the right femur from a male aged 59 years, arterial injection.
Spalteholz cleared specimen. Slightly enlarged. The intraosseous
distribution of the radiate arteries of the lower end of the femur can
be seen to resemble the pattern at birth (see figs. 6, 7). Note the free
anastomosis between these radiate arteries within the substance of
the bone.
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
Henry V. Crock
PLATE 1
209
PLATE 2
EXPLANATION OF FIGURES
210
9
A radiograph of a distal transverse section from the lower end of
the femur from a male aged 81 years, venous injection. Note the
caliber of the main radiate veins and the wavy outlines of their
principal tributaries, which enter them a t right angle junctions. Subarticular collecting veins can be identified over the medial femoral
condyle, but they are not shown to advantage i n radiographs (see
fig. 10).
10
A photograph of a distal transverse section from the lower end of
the right femur from a male aged 71 years, venous injection. Spalteholz cleared specimen. Slightly enlarged. The specimen was orientated with the articular surface uppermost and the light source
arranged to highlight the subarticular collecting vein system.
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
Henry V. Crock
PLATE 2
211
PLATE 3
EXPLANATION O F FIGURES
11 A photograph of a patella from a female child aged five days, arterial
injection. Spalteholz cleared specimen. X V 3 approx. The patella
has been dissected free of all overlying structures, the prepatellar
arterial plexus being left undisturbed.
12 A photograph of a median sagittal section from the patella illustrated
i n figure 11, arterial injection. The patella is entirely cartilaginous.
The complex prepatellar arterial plexus gives rise to a simple pattern
of vessels within the patella itself. The main arteries of supply enter
a t the center and lower pole; this pattern remains constant throughout life.
13 A radiograph of a median sagittal section from the patella of a male
aged 81 years, venous injection. The subarticular collecting veins are
clearly shown. The main stem of the inferior pole vein can be seen
corresponding i n location to the arteries of the lower pole of the
patella (see fig. 12).
14
A photomicrograph of a histological section from the specimen illustrated in figure 13, venous injection. Celloidin section, 400 p. X 3h
approx. The orientation of the subarticular collecting vein is clearly
shown, lying parallel to the articular cartilage, but separated from
its deerest layer by a well defined bony trabecula.
15
A detailed photomicrograph of the lower pole of the patella illustrated
i n figures 13, 14, X 5 approx.
16 A detailed photomicrograph from the lower pole of the patella illustrated i n figures 11, 12, 13, x 10 approx. The calcified zone of the
articular cartilage appears as a dark line just to the right of the mid
line in this plate. Beneath it, the supporting bony trabecula can be
seen, perforated at regular intervals by tributaries of the prominent
subarticular collecting vein. These vessels are referred to in the text
as the venous stems of subchondral capillaries.
17 A photomicrograph of a histological section cut i n a transverse plane
from the patella illustrated in figures 13-16, X 150 approx, venous
injection. Celloidin section 40 p. The calcified zone of the articular
cartilage is seen near the top of the plate. Beneath it the subarticular
bony trabecula is perforated by three channels transmitting partially
filled vessels which converge on to a large subarticular collecting vein.
These are referred to in the text as the venous limbs of subchondral
capillary loops.
212
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
Henry V Crock
PLATE 3
213
PLATE 4
EXPLANATION O F FIGURES
18 A photograph of a transverse section of the upper end of the tibia
from a male aged 50 years, arterial injection. Spalteholz cleared specimen. Slightly enlarged. The pattern of distribution of the radiate
arteries of the upper end of the tibia is clearly shown. In the center
of the specimen the main stems of the intercondylar radiate arteries
can be seen.
19
214
A photograph of a transverse section of the upper end of the right
tibia from a male aged 71 years. Spalteholz cleared specimen.
Slightly enlarged. Venous injection. The subarticular collecting veins
can be seen running in parallel wavy lines, orientated anteroposteriorly beneath both tibial condyles. These veins can be seen gathering together at the articular margins particularly on the medial tibial
condyle. In the anterior intercondylar area the stems of two emerging radiate veins can be seen and into these flow the sub-articular
collecting veins.
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
Henry V. Crock
PLATE 4
215
20-21
Photographs of median sagittal sections from the upper end of
the right tibia from a female aged nine years, arterial injection.
Spalteholz cleared specimens. The inferior genicular and intercondylar radiate epiphyseal arteries are shown. Within the bone
the upper tibia1 epiphyseal plate forms a barrier between metaphyseal and epiphyseal arteries. The superior metaphyseal arteries
of the human tibia are large vessels as shown in figure 21 in
particular.
EXPLANATION OF FIGURES
PLATE 5
HUMAN KNEE JOINT INTRAOSSEOUS VESSELS
Henry V. Crock
PLATE 5
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drainage, venous, joint, knee, supply, human, bones, arterial
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