Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury View Full Text


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Article Info

DATE

2019-02-26

AUTHORS

Taehoon Kang, Do Weon Lee, Jae Young Park, Hyuk-Soo Han, Myung Chul Lee, Du Hyun Ro

ABSTRACT

PurposePopliteal artery injury is a rare but devastating complication of open-wedge high tibial osteotomy (OWHTO). The objectives of this study were: to document the location of the artery in the virtual osteotomy plane (VOP), to measure the minimal distance between the popliteal artery and three virtual saw-progression lines (VSLs), and to present a safe sawing technique for OWHTO.MethodIn total, 45 computed tomography angiographies were reconstructed and virtual osteotomy was simulated using 3D image-processing software. The VOP was defined as an inclined plane commencing 3.5 cm below the articular plane towards the fibular head. VSLs were defined as saw-progression guidelines that lie on the VOP: “VSL-mid” runs from the midpoint of the tibial medial cortex towards the fibular head; “VSL-ant” starts from the same point as VSL-mid, but runs 10° anterior to the fibular head; and “VSL-post” runs 10° posterior to the fibular head. The distances between the popliteal artery and the three VSLs were measured, and the risk of injury was assessed.ResultsThe popliteal artery was located 20.7° posterior to VSL-mid and 51 mm from the starting point. The minimum distance between the popliteal artery and VSL-mid was 18 mm (99% confidence interval 9–27 mm). When the saw was moved along VSL-mid, 42% of the arteries were susceptible to injury. However, when it followed VSL-ant, there was no risk of injury.ConclusionsSawing toward the fibular head carries a risk of popliteal artery injury and should not be performed. When sawing in OWHTO, the recommended target should be 10° anterior to the fibular head. This technique eliminates the risk of popliteal artery injury. More... »

PAGES

1365-1371

References to SciGraph publications

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  • 2017-11-30. Satisfactory functional and radiological outcomes can be expected in young patients under 45 years old after open wedge high tibial osteotomy in a long-term follow-up in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
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  • 2018-05-21. Posterior cortical breakage leads to posterior tibial slope change in lateral hinge fracture following opening wedge high tibial osteotomy in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
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  • 2018-12-01. Pseudoaneurysm Formation due to Popliteal Artery Injury Caused by Drilling during Medial Opening Wedge High Tibial Osteotomy in KNEE SURGERY & RELATED RESEARCH
  • 2009-10-17. Results of high tibial osteotomy: review of the literature in INTERNATIONAL ORTHOPAEDICS
  • 2015-08-08. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
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    http://scigraph.springernature.com/pub.10.1007/s00167-019-05439-w

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    http://dx.doi.org/10.1007/s00167-019-05439-w

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1112390334

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30809721


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