anastomosis around knee joint

 The Popliteal Artery

 
(A. Poplitea)     1

The popliteal artery (Fig.
551) is the continuation of
the femoral, and courses
through the popliteal fossa.
It extends from the opening
in the Adductor magnus, at
the junction of the middle
and lower thirds of the thigh,
downward and lateralward to
anastomosis around knee joint

the intercondyloid fossa of

the femur, and then
vertically downward to the
lower border of the
Popliteus, where it divides
into anterior and posterior
tibial arteries.
 
Relations.—In front of the     2
artery from above downward
are the popliteal surface of
the femur (which is
separated from the vessel by
some fat), the back of the
knee-joint, and the fascia
covering the
Popliteus. Behind, it is
overlapped by the
Semimembranosus above,
and is covered by the
Gastrocnemius and Plantaris
below. In the middle part of
its course the artery is
separated from the
integument and fasciæ by a
quantity of fat, and
is crossed from the lateral to
the medial side by the tibial
anastomosis around knee joint

nerve and the popliteal vein,

the vein being between the
nerve and the artery and
closely adherent to the
latter. On its lateral side,
above, are the Biceps
femoris, the tibial nerve, the
popliteal vein, and the lateral
condyle of the femur; below,
the Plantaris and the lateral
head of the Gastrocnemius.
On its medial side, above,
are the Semimembranosus
and the medial condyle of
the femur; below, the tibial
nerve, the popliteal vein,
and the medial head of the
Gastrocnemius. The relations
of the popliteal lymph glands
to the artery are described
above.
 
Peculiarities in Point of     3
Division.—Occasionally the
popliteal artery divides into
its terminal branches
opposite the knee-joint. The
anterior tibial under these
anastomosis around knee joint

circumstances usually passes

in front of the Popliteus.
 
Unusual Branches.—The     4
artery sometimes divides
into the anterior tibial and
peroneal, the posterior tibial
being wanting, or very small.
Occasionally it divides into
three branches, the anterior
and posterior tibial, and
peroneal.
 
Branches.—The branches of     5
the popliteal artery are:
Lateral
Superior Superior
Muscular Genicular.
Middle
Sural.
Genicular.
Medial
Cutaneous. Inferior
Genicular.
Lateral
Medial Superior
Inferior
Genicular
Genicular.
  The superior muscular     6
branches, two or three in
anastomosis around knee joint

number, arise from the
upper part of the artery, and
are distributed to the lower
parts of the Adductor
magnus and hamstring
muscles, anastomosing with
the terminal part of the
profunda femoris.
  The sural arteries (aa.     7
surales; inferior muscular
arteries) are two large
branches, which are
distributed to the
Gastrocnemius, Soleus, and
Plantaris. They arise from
the popliteal artery opposite
the knee-joint.
  The cutaneous     8
branches arise either from
the popliteal artery or from
some of its branches; they
descend between the two
heads of the Gastrocnemius,
and, piercing the deep
fascia, are distributed to the
skin of the back of the leg.
One branch usually
accompanies the small
anastomosis around knee joint

saphenous vein.
  The superior genicular     9
arteries (aa. genu
superiores; superior articular
arteries) (Figs. 550, 551),
two in number, arise one on
either side of the popliteal,
and wind around the femur
immediately above its
condyles to the front of the
knee-joint. The medial
superior genicularruns in
front of the
Semimembranosus and
Semitendinosus, above the
medial head of the
Gastrocnemius, and passes
beneath the tendon of the
Adductor magnus. It divides
into two branches, one of
which supplies the Vastus
medialis, anastomosing with
the highest genicular and
medial inferior genicular
arteries; the other ramifies
close to the surface of the
femur, supplying it and the
knee-joint, and
anastomosis around knee joint

anastomosing with the

lateral superior genicular
artery. The medial superior
genicular artery is frequently
of small size, a condition,
which is associated with an
increase in the size of the
highest genicular.
The lateral superior
genicularpasses above the
lateral condyle of the femur,
beneath the tendon of the
Biceps femoris, and divides
into a superficial and a deep
branch; the superficial
branch supplies the Vastus
lateralis, and anastomoses
with the descending branch
of the lateral femoral
circumflex and the lateral
inferior genicular arteries;
the deep branch supplies the
lower part of the femur and
knee-joint, and forms an
anastomotic arch across the
front of the bone with the
highest genicular and the
medial inferior genicular
anastomosis around knee joint

arteries.
  The middle genicular     1
artery (a. genu media; 0
azygos articular artery) is a
small
branch, arising opposite the
back of the knee-joint. It
pierces the oblique popliteal
ligament, and supplies the
ligaments and synovial
membrane in the interior of
the articulation.
  The inferior genicular     1
arteries (aa. genu 1
inferiores; inferior articular
arteries) (Figs. 550, 551),
two in number, arise from
the popliteal beneath the
Gastrocnemius. The medial
inferior genicular first
descends along the upper
margin of the Popliteus, to
which it gives branches; it
then passes below the
medial condyle of the tibia,
beneath the tibial collateral
ligament, at the anterior
border of which it ascends to
anastomosis around knee joint

the front and medial side of

the joint, to supply the upper
end of the tibia and the
articulation of the knee,
anastomosing with the
lateral inferior and medial
superior genicular arteries.
The lateral inferior
genicular runs lateralward
above the head of the fibula
to the front of the knee-
joint, passing in its course
beneath the lateral head of
the Gastrocnemius, the
fibular collateral ligament,
and the tendon of the Biceps
femoris. It ends by dividing
into branches, which
anastomose with the medial
inferior and lateral superior
genicular arteries, and with
the anterior recurrent tibial
artery.
anastomosis around knee joint

FIG. 552– Circumpatellar
anastomosis. (Larger image)
 
 
The Anastomosis Around     1
the Knee-joint (Fig. 552). 2
—Around and above the
patella, and on the
contiguous ends of the femur
and tibia, is an intricate net-
work of vessels forming a
superficial and a deep
plexus. Thesuperficial
plexus is situated between
the fascia and skin around
about the patella, and forms
three well-defined arches:
one, above the upper border
of the patella, in the loose
connective tissue over the
anastomosis around knee joint

Quadriceps femoris; the

other two, below the level of
the patella, are situated in
the fat behind the
ligamentum patellæ.
The deep plexus, which
forms a close net-work of
vessels, lies on the lower
end of the femur and upper
end of the tibia around their
articular surfaces, and sends
numerous offsets into the
interior of the joint. The
arteries which form this
plexus are the two medial
and the two lateral genicular
branches of the popliteal, the
highest genicular, the
descending branch of the
lateral femoral circumflex,
and the anterior recurrent
tibial.
Clinical relevance
The Genicular anastomosis provides collateral circulation to supply the leg when the knee is fully
flexed[2].

When the knee suffers a popliteal aneurysm. If the femoral artery has to be ligated surgically, blood

can still reach the popliteal artery distal to the ligation via the genicular anastomosis