Anatomy of the bony perforators veins of the knee

Introduction: The aim of this study is to make an anatomical description of the bony venous perforators (PVs) at the knee level witch are frequently missed during investigation of patients with chronic venous disease.Material and methods: Multiple series of anatomical slices of fresh cadavers injected with green latex and series of CT venographies as well as Duplex color investigations were used to study their precise location and the connections with the venous network of the knee.Results: Anatomically, these PVs are commonly located anteriorly around the patella, and posteriorly in the inter-condylar grove, medially and laterally. Their connections with the popliteal vein are multiple.During Duplex ultrasound assessment, as well as CT venography, they are often ignored due to their small caliber.Discussion and conclusions: Physiological hypothesis: At the knee level, The spongy bone of both tibia and femur epiphysis is an important place of production of red blood cells. They connect the venous system in the popliteal vein by several tiny perforators.In practice, these tiny perforators are not investigated and ignored by the sonographers. They should be distinguished from the big PVs of the tibial diaphysis responsible for varicose veins of the leg [1 Ramelet AA, Crebassa V, D' Alotto C, et al. Anomalous intraosseous venous drainage: Bone perforators? Phlebology. 2016;32(4):241–248.[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]]. These PVs could also be linked to the so-called “phleboarthrosis” described recently [2 Giovanni B, Agus M, Agus A. Phleboarthrosis. Acta Phlebologica. 2017;18(3):63–64. [Google Scholar]].The bony perforator veins of the knee are commonly responsible for reticular veins or telangiectases around the knee, but they are underdiagnosed by the sonographers. This explains why the injection of these cosmetic lesions around the knee frequently leads to recurrence.