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Adequate Protection Rather Than Knee Flexion Prevents Popliteal Vascular Injury During High Tibial Osteotomy: Analysis of Three-Dimensional Knee Models in Relation to Knee Flexion and Osteotomy Techniques

Authors
 Chong-Hyuk Choi  ;  Woo-Suk Lee  ;  Min Jung  ;  Hyun-Soo Moon  ;  Young-Han Lee  ;  Jongtaek Oh  ;  Sung-Jae Kim  ;  Sung-Hwan Kim 
Citation
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol.28(5) : 1425-1435, 2020-05 
Journal Title
 KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY 
ISSN
 0942-2056 
Issue Date
2020-05
Keywords
3-Dimensional analysis ; Anatomy ; Knee ; Osteotomy ; Vascular injury ; Virtual surgery
Abstract
Purpose: (1) To analyse popliteal artery (PA) movement in a three-dimensional (3D) coordinate system in relation to knee flexion and high tibial osteotomy (HTO) techniques (lateral closed wedge HTO [LCHTO], uniplane medial open wedge HTO [UP-MOHTO], biplane medial open wedge HTO [BP-MOHTO]) and (2) to identify safe zones of the PA in each osteotomy plane. Methods: Sixteen knees of patients who underwent magnetic resonance imaging with extension and 90° flexion were used to develop subject-specific 3D knee flexion models. Displacement of the PA during knee flexion was measured along the X- and Y-axis, as was the distance between the posterior tibial cortex and PA parallel to the Y-axis (d-PCA). Frontal plane safety index (FPSI) and maximal axial safe angles (MASA) of osteotomy, which represented safe zones for the osteotomy from the PA injury, were analysed. All measurements were performed along virtual osteotomy planes. Differences among the three osteotomy methods were analysed for each flexion angle using a linear mixed model. Results: The average increments in d-PCA during knee flexion were 1.3 ± 2.3 mm in LCHTO (n.s.), 1.4 ± 1.2 mm in UP-MOHTO (P < 0.0001), and 1.7 ± 2.0 mm in BP-MOHTO (P = 0.015). The mean FPSIs in knee extension were 37.6 ± 5.9%, 46.4 ± 5.8%, and 45.1 ± 8.1% for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. The mean MASA values in knee extension were 45.8° ± 4.4°, 37.3° ± 6.1°, and 38.9° ± 6.5° for LCHTO, UP-MOHTO, and BP-MOHTO, respectively. Conclusion: Although the PA moved posteriorly during knee flexion, the small (1.7 mm) increment thereof and inconsistent movements in subjects would not be of clinical relevance to PA safety during HTO. Level of evidence: Diagnostic study, Level II.
Full Text
https://link.springer.com/article/10.1007%2Fs00167-019-05515-1
DOI
10.1007/s00167-019-05515-1
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Jae(김성재)
Kim, Sung Hwan(김성환) ORCID logo https://orcid.org/0000-0001-5743-6241
Moon, Hyun-Soo(문현수)
Oh, Jong Taek(오종택) ORCID logo https://orcid.org/0000-0002-8312-4281
Lee, Young Han(이영한) ORCID logo https://orcid.org/0000-0002-5602-391X
Lee, Woo Suk(이우석) ORCID logo https://orcid.org/0000-0002-0798-1660
Jung, Min(정민) ORCID logo https://orcid.org/0000-0002-7527-4802
Choi, Chong Hyuk(최종혁) ORCID logo https://orcid.org/0000-0002-9080-4904
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/176144
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