Association of High Posterior Condylar Angle, Low Popliteus Sulcus Depth, and Low Popliteus Sulcus Depth Lateral...

Aberrant anterior tibial artery (AATA) is an uncommon variation of the anterior tibial artery. It is an important vascular variation that increases the risk of vascular complications in some knee surgeries (high tibial osteotomy, posterior cruciate ligament reconstruction, etc).

The anatomic and morphometric features of AATA remain unclear. The authors hypothesize that the posterior femoral morphology and popliteus muscle-related features may be associated with the presence of AATA.

Cross-sectional study; Level of evidence, 3.

Between December 2022 and December 2024, knee magnetic resonance imaging (MRIs) were analyzed to detect AATA. Images in which image analysis was not optimal due to artifacts, images of patients with previous surgery around the knee, and patients with vascular malformations in the lower extremity were excluded. A control group was formed through computer-assisted randomization, comprising an equal number of men and women with AATA as patients. The condylar twist angle, posterior condylar angle (PCA), posterior tibiofemoral angle, popliteus sulcus depth (PSD), and PSD/lateral condylar width (LCW) parameters were measured on the MRIs of all patients and recorded for each patient. Patients with AATA variation were scanned for the presence of MRI of the opposite knee outside the time interval determined for the study, and it was analyzed whether patients with opposite knee MRIs had bilateral AATA.

After applying the inclusion and exclusion criteria, 4075 knee MRIs were analyzed. A total of 78 AATA variations were detected, with a prevalence of 1.91%. The prevalence of AATA was 2.04% in women and 1.78% in men. The PCA was statistically higher in patients with AATA compared with the control group (P < .005). PSD and PSD/LCW were found to be lower in patients with AATA compared with the control group (P = .012, P = .05). The prevalence of bilateral AATA in patients with AATA variation was 48.5%.

The prevalence of AATA was found to be 1.91%. High PCA, low PSD, and PSD/LCW are radiologic parameters associated with AATA variation. Both the popliteus musculature and posterior femoral morphometry are related to the occurrence of AATA variation.