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The safety and feasibility of a less invasive distal femur closing wedge osteotomy technique: a cadaveric dissection study of the medial aspect of the distal femur

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the feasibility and safety of a less invasive surgical approach to the distal medial aspect of the femur in supracondylar medial closing wedge osteotomy for the treatment of lateral compartment osteoarthritis of the knee. The aim of a less invasive approach is to minimize soft tissue disruption, reduce damage to neurovascular structures and thereby prevent muscle atrophy and optimize bone healing potential.

Methods

A human cadaver dissection study on the vascular and neural structures of the medial side of the distal femur was conducted. Surgical dissection (n = 4), cryomicrotomy and subsequent 3D reconstruction of the anatomy (n = 1), and surgical dissection after performance of a supracondylar osteotomy through a less invasive approach (n = 1) were performed in 6 legs in total.

Results

The surgical dissection and 3D reconstruction showed that a branch of the femoral artery, the distal genicular artery, supplies the distal area of the vastus medialis (VM) muscle. This artery has several branching patterns; crucial in the presented less invasive approach is its musculo-articular branch, which has an oblique course through the VM to the superomedial pole of the patella. The femoral nerve and saphenous nerve innervate the VM. These structures are at risk in the traditional subvastus approach, whereas no major damage was observed in the leg in which a less invasive approach was performed.

Conclusions

In this cadaveric dissection study, a less invasive approach to the medial side of the distal femur proved to be feasible and safe. Damage to the VM and its neurovascular structures is minimized as compared to the traditional subvastus approach.

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Acknowledgments

The authors would like to thank Nizar Moayeri for his help with the 3D cryomicrotome analysis and Willem van Wolferen, Jan-Willem de Groot and Frank de Graaff for their help with the preparation of the legs. J.M. Brinkman would like to thank the Marti-Keuning Eckhardt Foundation for their support of his scientific work.

Conflict of interest

None declared by all authors.

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Authors and Affiliations

  1. Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands

    J. Visser & R. M. Castelein

  2. Department of Orthopaedics Maartenskliniek Woerden, Limb Deformity Reconstruction Unit, Polanerbaan 2, 3447 GN, Woerden, The Netherlands

    J. -M. Brinkman & R. J. van Heerwaarden

  3. Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands

    R. L. A. W. Bleys

Authors
  1. J. Visser
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  2. J. -M. Brinkman
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  3. R. L. A. W. Bleys
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  4. R. M. Castelein
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  5. R. J. van Heerwaarden
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Corresponding author

Correspondence to R. J. van Heerwaarden.

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Visser, J., Brinkman, J.M., Bleys, R.L.A.W. et al. The safety and feasibility of a less invasive distal femur closing wedge osteotomy technique: a cadaveric dissection study of the medial aspect of the distal femur. Knee Surg Sports Traumatol Arthrosc 21, 220–227 (2013). https://doi.org/10.1007/s00167-012-2133-0

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