Dear OCAD friends.
I did not receive any explanation for my findings, except for a handful who had seen the same type of findings – but did not know why there is so much going on at the anterior distal femur.
But today I received this information from Szabolcs – who points to the anastomosis close to the synovial membrane, maybe as a predisposition for ingrowth of synovia and actually usuration of bone? This could be an important piece of the puzzle.
Thank you! Should anyone find any nice cases or have further good ideas – please let me know 🙂
Best regards
Roar
Hi,
There is no name of those vessels, it is a anastomosing plexus between lateral/medial genicular vessels.
https://en.wikipedia.org/wiki/Descending_genicular_artery
I think the venous/arterial plexus in the prefemoral fat pat (PFP) with penetrating branches to the bone + the fact that the synovial membrane covering the fat pad has connection to the femoral cortex where the distal end of the PFP ends, creates a unique anatomical consideration which was nicely described by Bill Morrison in his Emory talk.
Good morning!
I have a question about an area of the distal femur where we often see some changes – maybe coincidental, and we haven’t yet found any literature to explain this area.
It is about the anterior distal femur, just proximal to the trochlea, beneath the fat pad. There are usually some vessels perforating the cortex in this area (can not even find any names for these vessels), and it seems like these vessels can create some strange structures within the femur, sometimes fanning out, sometimes creating straight vessels going proximal within the femur either beneath the cortex or in the middle of the bone, sometimes larger anastomoses with posterior knee.
But not just the vessels, we see cortical lytic changes, bone marrow edema and even seen an OO in that area.
Can anyone explain why this is such a high-activity area?
Have a look at my slide, showing from left to right, upper then lower:
– perforating, normal looking vessels
– vessels fanning out and communicating with large dilated posterior knee vessels
– small cortical defects/irregularities
– edema and cortical changes, believed to be stress reaction, normalized after a few weeks
– a confirmed OO
– a large cortical defect, edema in the fat pad, no obvious etiology
Have a nice sunday, heavy rain in Norway – perfect for MSK cases indoors
Best
