title: Vascular injuries during closing-wedge high tibial osteotomy: A cadaveric angiographic study.
abstract: BACKGROUND
  Closing-wedge high tibial osteotomy is a surgical option for patients with isolated medial compartment osteoarthritis and varus knee alignment. Vascular complications are rare, but incriminate the use of oscillating saw or osteotome. It is important to know the steps of this surgery that involve risk of vascular injury and what to do to decrease that risk.
  
  
  OBJECTIVE
  Performing the distal osteotomy cut using an oscillating saw is a step with high risk of vascular injury. A protective device behind the tibia may decrease this risk.
  
  
  METHODS
  In this descriptive angiographic cadaver study, closing-wedge high tibial osteotomy was performed on 6 cadaveric knees in 90° knee flexion, and the distance between the surgical instrument and the popliteal artery was measured on fluoroscopy with artery opacification at the various steps of surgery.
  
  
  RESULTS
  Tibial osteotomy with oscillating saw involves high vascular risk: the mean distance between the saw-blade and the popliteal artery is 10.6mm in 90° knee flexion. Using a specific device placed behind the tibia protects the vascular structures.
  
  
  CONCLUSIONS
  High tibial osteotomy is indicated in medial compartment osteoarthritis of the knee and can be performed by closing or opening-wedge. Vascular injuries in closing-wedge osteotomy exist and it is recommended to perform this surgery at 90° knee flexion, although some studies report that this does not move the artery out of the way. A risk of vascular lesion should be kept in mind. The oscillation of the saw and the direction of the osteotomy should also be taken into consideration when performing a closing-wedge high tibial osteotomy in order to protect the popliteal artery.
  
  
  METHODS
  Descriptive cadaver study. Level IV.
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Laboratoire d'anatomie, faculté de médecine Rockefeller, université Claude-Bernard Lyon 1, 8, avenue Rockefeller, 69003 Lyon, France. Electronic address: alice.darnis@icloud.com.
authors.forename: A
authors.initials: A
authors.lastname: Darnis
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: V
authors.initials: V
authors.lastname: Villa
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Debette
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Lustig
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: E
authors.initials: E
authors.lastname: Servien
authors.affiliation: Service de chirurgie orthopédique, centre Albert-Trillat, université Claude-Bernard Lyon 1, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Neyret
mesh_terms: D000792:Angiography; D002102:Cadaver; D006801:Humans; D010027:Osteotomy / Q000009:adverse effects*; D011150:Popliteal Artery / Q000293:injuries*; D013977:Tibia / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D057772:Vascular System Injuries / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Anatomical study; Closing-wedge; High tibial osteotomy; Popliteal artery; Vascular injury