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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Abbreviations

OWHTO:

Open-wedge high tibial osteotomy

CT:

Computed tomography

CTA:

Computed tomography angiography

VOL:

Virtual osteotomy line

VOP:

Virtual osteotomy plane

CI:

Confidence interval

HU:

Hounsfield unit

DICOM:

Digital Imaging and Communications in Medicine

PACS:

Picture Archiving and Communication System

MPR:

Multiplanar reconstruction

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Funding

This research was supported by the Bio and Medical Technology Development Program of the National Research Foundation (NRF) funded by the Ministry of Science and ICT (NRF-2017R1A2B4011966).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

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

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  1. Taehoon Kang
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  2. Do Weon Lee
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  4. Hyuk-Soo Han
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Correspondence to Du Hyun Ro.

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This study was approved by the institutional review board of Seoul National University College of Medicine, Seoul National University Hospital (IRB no. 1708-154-879).

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Kang, T., Lee, D.W., Park, J.Y. et al. Sawing toward the fibular head during open-wedge high tibial osteotomy carries the risk of popliteal artery injury. Knee Surg Sports Traumatol Arthrosc 28, 1365–1371 (2020). https://doi.org/10.1007/s00167-019-05439-w

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  • DOI: https://doi.org/10.1007/s00167-019-05439-w

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