Introduction: Closing-wedge high tibial osteotomy is a surgical option for patients with isolated medialcompartment osteoarthritis and varus knee alignment. Vascular complications are rare, but incriminatethe use of oscillating saw or osteotome. It is important to know the steps of this surgery that involve riskof vascular injury and what to do to decrease that risk.

 

Hypothesis: Performing the distal osteotomy cut using an oscillating saw is a step with high risk of vascularinjury. A protective device behind the tibia may decrease this risk.Materials and methods: In this descriptive angiographic cadaver study, closing-wedge high tibialosteotomy was performed on 6 cadaveric knees in 90◦knee flexion, and the distance between the surgicalinstrument and the popliteal artery was measured on fluoroscopy with artery opacification at the varioussteps of surgery.

 

Results: Tibial osteotomy with oscillating saw involves high vascular risk: the mean distance between thesaw-blade and the popliteal artery is 10.6 mm in 90◦knee flexion. Using a specific device placed behindthe tibia protects the vascular structures.

 

Discussion: High tibial osteotomy is indicated in medial compartment osteoarthritis of the knee and canbe performed by closing or opening-wedge. Vascular injuries in closing-wedge osteotomy exist and it isrecommended to perform this surgery at 90◦knee flexion, although some studies report that this doesnot move the artery out of the way. A risk of vascular lesion should be kept in mind. The oscillation ofthe saw and the direction of the osteotomy should also be taken into consideration when performing aclosing-wedge high tibial osteotomy in order to protect the popliteal artery.

 

Study design: Descriptive cadaver study. Level IV.

 

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