Anterior tibial artery

The anterior tibial artery is the main arterial supply of the anterior compartment of the leg. 

Gross anatomy

The anterior tibial artery arises from the popliteal artery in the popliteal fossa and continues distally as the dorsalis pedis artery.

Course

The popliteal artery usually divides at the distal border of the popliteus muscle into the tibioperoneal trunk and anterior tibial artery. 

While still in the posterior compartment of the leg, the anterior tibial artery gives off the:

• posterior tibial recurrent artery
• circumflex fibular artery

Subsequently, it passes through a gap above the interosseous membrane into the anterior compartment of the leg. Here it lies on the interosseous membrane, lateral to tibialis anterior muscle.

The anterior tibial artery passes in front of the ankle joint and continues as the dorsalis pedis artery onto the dorsum of the foot lateral to the tendon of the extensor hallucis longus and medial to the extensor digitorum longus and deep peroneal nerve. 

Branches

Branches include:

• anterior tibial recurrent artery: arises immediately, passes upward in the tibialis anterior muscle to anastomose with lateral genicular branches (of the popliteal artery) at the knee
• muscular branches
• perforating branches: pass behind extensor digitorum longus, piercing the deep fascia and supplying the skin of the anterior leg
• anterior medial malleolar artery: anastomoses with the medial malleolar branch of the posterior tibial artery
• anterior lateral malleolar artery: anastomoses with the perforating branch of the peroneal artery

Variant anatomy

• high-origin/high-division anterior tibial artery ⁴
  • origin above proximal to the popliteus muscle belly
  • prevalence ~3%
• aberrant anterior tibial artery ⁵
  • high-origin anterior tibial artery that courses between the posterior tibial cortex and popliteus
  • prevalence ~2.5%

Clinical importance

Recognition of high-origin and aberrant anterior tibial arteries is important to reduce the risk of inadvertent vascular injury, during knee surgery (e.g. arthroplasty, high tibial osteotomy, lateral meniscal repair, posterior cruciate ligament reconstruction) ^4,5.