Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury
Purpose Popliteal 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 v...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1365-1371 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Kang, Taehoon Lee, Do Weon Park, Jae Young Han, Hyuk-Soo Lee, Myung Chul Ro, Du Hyun |
| description | Purpose
Popliteal 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.
Method
In 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.
Results
The 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.
Conclusions
Sawing 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. |
| doi_str_mv | 10.1007/s00167-019-05439-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2186627446</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2185979050</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-1f4f18b0b3e267337e9be79e8d3e4852785dce58e881dd69901397c214a324f93</originalsourceid><addsrcrecordid>eNp9kc1u1DAUhS0EokPLC7BAltiwMb3-SRwvUVV-pEosSteWE9_MeMjEwXYUzduT6RSQWLC6lu53ji1_hLzh8IED6OsMwGvNgBsGlZKGLc_IhispmZZKPycbMEowAVV9QV7lvAdYj8q8JBcSGjBa8A1J924J45aWuLjkadkh7UM7Dy7RHTpP_ZxO6zjhyBb0W6S7sN3REtrgBhpzwVji4Ug7l1LA_FiQQv5BY0-nOA2h4Mq5VDAdaRj3czpekRe9GzK-fpqX5OHT7febL-zu2-evNx_vWCd1VRjvVc-bFlqJotZSajQtaoONl6iaSuim8h1WDTYN9742Brg0uhNcOSlUb-QleX_unVL8OWMu9hByh8PgRoxztoI3dS20UvWKvvsH3cc5jevrTlRltIEKVkqcqS7FnBP2dkrh4NLRcrAnI_ZsxK5G7KMRu6yht0_Vc3tA_yfyW8EKyDOQp9NXY_p7939qfwFll5d7</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2185979050</pqid></control><display><type>article</type><title>Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury</title><source>Wiley Online Library All Journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Kang, Taehoon ; Lee, Do Weon ; Park, Jae Young ; Han, Hyuk-Soo ; Lee, Myung Chul ; Ro, Du Hyun</creator><creatorcontrib>Kang, Taehoon ; Lee, Do Weon ; Park, Jae Young ; Han, Hyuk-Soo ; Lee, Myung Chul ; Ro, Du Hyun</creatorcontrib><description>Purpose
Popliteal 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.
Method
In 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.
Results
The 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.
Conclusions
Sawing 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.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-019-05439-w</identifier><identifier>PMID: 30809721</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Arteries ; Arthritis ; Biocompatibility ; Communications systems ; Computed tomography ; Computer simulation ; Confidence intervals ; Digital imaging ; Head ; Health risks ; Image processing ; Image reconstruction ; Injuries ; Knee ; Magnetic resonance imaging ; Medicine ; Medicine & Public Health ; Orthopedics ; Osteoarthritis ; Osteotomy ; Sawing ; Surgery ; Wedges</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1365-1371</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-1f4f18b0b3e267337e9be79e8d3e4852785dce58e881dd69901397c214a324f93</citedby><cites>FETCH-LOGICAL-c375t-1f4f18b0b3e267337e9be79e8d3e4852785dce58e881dd69901397c214a324f93</cites><orcidid>0000-0001-6199-908X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-019-05439-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-019-05439-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30809721$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kang, Taehoon</creatorcontrib><creatorcontrib>Lee, Do Weon</creatorcontrib><creatorcontrib>Park, Jae Young</creatorcontrib><creatorcontrib>Han, Hyuk-Soo</creatorcontrib><creatorcontrib>Lee, Myung Chul</creatorcontrib><creatorcontrib>Ro, Du Hyun</creatorcontrib><title>Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Popliteal 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.
Method
In 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.
Results
The 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.
Conclusions
Sawing 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.</description><subject>Arteries</subject><subject>Arthritis</subject><subject>Biocompatibility</subject><subject>Communications systems</subject><subject>Computed tomography</subject><subject>Computer simulation</subject><subject>Confidence intervals</subject><subject>Digital imaging</subject><subject>Head</subject><subject>Health risks</subject><subject>Image processing</subject><subject>Image reconstruction</subject><subject>Injuries</subject><subject>Knee</subject><subject>Magnetic resonance imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Osteoarthritis</subject><subject>Osteotomy</subject><subject>Sawing</subject><subject>Surgery</subject><subject>Wedges</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kc1u1DAUhS0EokPLC7BAltiwMb3-SRwvUVV-pEosSteWE9_MeMjEwXYUzduT6RSQWLC6lu53ji1_hLzh8IED6OsMwGvNgBsGlZKGLc_IhispmZZKPycbMEowAVV9QV7lvAdYj8q8JBcSGjBa8A1J924J45aWuLjkadkh7UM7Dy7RHTpP_ZxO6zjhyBb0W6S7sN3REtrgBhpzwVji4Ug7l1LA_FiQQv5BY0-nOA2h4Mq5VDAdaRj3czpekRe9GzK-fpqX5OHT7febL-zu2-evNx_vWCd1VRjvVc-bFlqJotZSajQtaoONl6iaSuim8h1WDTYN9742Brg0uhNcOSlUb-QleX_unVL8OWMu9hByh8PgRoxztoI3dS20UvWKvvsH3cc5jevrTlRltIEKVkqcqS7FnBP2dkrh4NLRcrAnI_ZsxK5G7KMRu6yht0_Vc3tA_yfyW8EKyDOQp9NXY_p7939qfwFll5d7</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Kang, Taehoon</creator><creator>Lee, Do Weon</creator><creator>Park, Jae Young</creator><creator>Han, Hyuk-Soo</creator><creator>Lee, Myung Chul</creator><creator>Ro, Du Hyun</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6199-908X</orcidid></search><sort><creationdate>20200501</creationdate><title>Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury</title><author>Kang, Taehoon ; Lee, Do Weon ; Park, Jae Young ; Han, Hyuk-Soo ; Lee, Myung Chul ; Ro, Du Hyun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-1f4f18b0b3e267337e9be79e8d3e4852785dce58e881dd69901397c214a324f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Arteries</topic><topic>Arthritis</topic><topic>Biocompatibility</topic><topic>Communications systems</topic><topic>Computed tomography</topic><topic>Computer simulation</topic><topic>Confidence intervals</topic><topic>Digital imaging</topic><topic>Head</topic><topic>Health risks</topic><topic>Image processing</topic><topic>Image reconstruction</topic><topic>Injuries</topic><topic>Knee</topic><topic>Magnetic resonance imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Osteoarthritis</topic><topic>Osteotomy</topic><topic>Sawing</topic><topic>Surgery</topic><topic>Wedges</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kang, Taehoon</creatorcontrib><creatorcontrib>Lee, Do Weon</creatorcontrib><creatorcontrib>Park, Jae Young</creatorcontrib><creatorcontrib>Han, Hyuk-Soo</creatorcontrib><creatorcontrib>Lee, Myung Chul</creatorcontrib><creatorcontrib>Ro, Du Hyun</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kang, Taehoon</au><au>Lee, Do Weon</au><au>Park, Jae Young</au><au>Han, Hyuk-Soo</au><au>Lee, Myung Chul</au><au>Ro, Du Hyun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>28</volume><issue>5</issue><spage>1365</spage><epage>1371</epage><pages>1365-1371</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Popliteal 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.
Method
In 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.
Results
The 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.
Conclusions
Sawing 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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30809721</pmid><doi>10.1007/s00167-019-05439-w</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-6199-908X</orcidid></addata></record> |
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| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-05, Vol.28 (5), p.1365-1371 |
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| language | eng |
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| source | Wiley Online Library All Journals; SpringerLink Journals - AutoHoldings |
| subjects | Arteries Arthritis Biocompatibility Communications systems Computed tomography Computer simulation Confidence intervals Digital imaging Head Health risks Image processing Image reconstruction Injuries Knee Magnetic resonance imaging Medicine Medicine & Public Health Orthopedics Osteoarthritis Osteotomy Sawing Surgery Wedges |
| title | Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury |
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