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Vascular Anatomy of the Meniscus

The vascular supply to the medial and lateral menisci originates predominantly from the medial and lateral genicular arteries (inferior and superior branches). Branches from these vessels give rise to a perimeniscal capillary plexus within the synovial and capsular tissues of the knee joint.

The plexus is an arborizing network of vessels that supplies the peripheral border of the meniscus about its attachment to the joint capsule . These perimeniscal vessels are oriented in a predominantly circumferential pattern, with radial branches being directed toward the center of the joint .

Anatomic studies have shown that the degrees of peripheral vascular penetration are 10% to 30% of the width of the medial meniscus and 10% to 25% of the width of the lateral meniscus. The middle genicular artery, along with a few terminal branches of the medial and lateral genicular vessels, also supplies vessels to the menisci through the vascular synovial covering of the anterior and posterior horn attachments .

These synovial vessels penetrate the horn attachments and give rise to smaller vessels that enter the meniscal horns for a short distance and end in terminal capillary loops.

A small reflection of the vascular synovial tissue is also present throughout the peripheral attachment of the medial and lateral menisci on the femoral and tibial articular surfaces. This “synovial fringe” extends for a short distance over the peripheral surfaces of the meniscus and contains small, terminally looped vessels. Although the synovial fringe is adherent to the articular surfaces of the menisci, it does not contribute vessels to the meniscus per se.The clinical significance of these fringe vessels lies in their potential contribution to the reparative response of the meniscus, as seen in “synovial abrasion” techniques.

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