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Ollivier M, Claes S, Mabrouk A, Elson D, Espejo-Reina A, Predescu V, Schröter S, Van Heerwarden R, Menetrey J, Beaufils P, Seil R, Beker R, Khakha R, Dawson M. Surgical strategy and complication management of osteotomy around the painful degenerative varus knee: ESSKA Formal Consensus Part II. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38769785 DOI: 10.1002/ksa.12273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE The purpose of the European consensus was to provide recommendations for the treatment of patients with a painful degenerative varus knee using a joint preservation approach. Part II focused on surgery, rehabilitation and complications after tibial or femoral correction osteotomy. METHODS Ninety-four orthopaedic surgeons from 24 countries across Europe were involved in the consensus, which focused on osteotomies around the knee. The consensus was performed according to the European Society for Sports Traumatology, Knee Surgery and Arthroscopy consensus methodology. The steering group designed the questions and prepared the statements based on the experience of the experts and the evidence of the literature. The statements were evaluated by the ratings of the peer-review groups before a final consensus was released. RESULTS The ideal hinge position for medial opening wedge high tibial osteotomy (MOW HTO) should be at the upper level of the proximal tibiofibular joint, and for lateral closing wedge distal femoral osteotomy (LCW DFO) just above the medial femoral condyle. Hinge protection is not mandatory. Biplanar osteotomy cuts provide more stability and quicker bony union for both MOW HTO and LCW DFO and are especially recommended for the latter. Osteotomy gap filling is not mandatory, unless structural augmentation for stability is required. Patient-specific instrumentation should be reserved for complex cases by experienced hands. Early full weight-bearing can be adopted after osteotomy, regardless of the technique. However, extra caution should be exercised in DFO patients. Osteotomy patients should return to sports within 6 months. CONCLUSION Clear recommendations for surgical strategy, rehabilitation and complications of knee osteotomies for the painful degenerative varus knee were demonstrated. In Part 2 of the consensus, high levels of agreement were reached by experts throughout Europe, under variable working conditions. Where science is limited, the collated expertise of the collaborators aimed at providing guidance for orthopaedic surgeons developing an interest in the field and highlighting areas for potential future research. LEVEL OF EVIDENCE Level II, consensus.
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Affiliation(s)
- Matthieu Ollivier
- CNRS, ISM, Aix Marseille University, Marseille, France
- Department of Orthopaedics and Traumatology, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Aix Marseille University, Marseille, France
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, Belgium
| | - Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, England, UK
| | - David Elson
- Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Vlad Predescu
- Department of Orthopedics and Traumatology, St Pantelimon Clinical Hospital Bucharest, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Steffen Schröter
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Tübingen, Germany
| | - Ronald Van Heerwarden
- Centre for Deformity Correction and Joint Preserving Surgery, Kliniek ViaSana, Mill, The Netherlands
| | - Jacques Menetrey
- Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland
| | - Philippe Beaufils
- Department of Orthopaedics and Traumatology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Roman Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg
| | - Roland Beker
- Center of Orthopaedics and Traumatology, University Hospital Brandenburg an der Havel, Medical School Brandenburg, Brandenburg, Germany
| | | | - Matthew Dawson
- North Cumbria University Hospital NHS Trust, North Cumbria, UK
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Kazemi SM, Keyhani S, Sadighi M, Hosseininejad SM. Navigation of femoral and popliteal artery around the knee with CT angiography: implications for surgical interventions. Surg Radiol Anat 2023; 45:1515-1523. [PMID: 37733017 DOI: 10.1007/s00276-023-03241-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Uncertainty about the exact position of the femoral and popliteal arteries in the medial thigh and posterior knee might increase vascular complications in surgical procedures. This study aimed to document femoral and popliteal arteries in the medial thigh and around the knee to assist surgeons in developing safer surgical approaches. METHODS The study included 120 patients-180 lower limbs-who underwent CT angiography (CTA) of the lower extremity. The distance from the femoral artery to the anterior border, midsagittal axis, and posterior border of the femur and the popliteal artery to the medial, lateral, and midpoint posterior cortex of the proximal tibia was measured in two- and three-dimensional CTA images. RESULTS The femoral artery was found to be on average 236.93 ± 29.61 mm, 195.34 ± 26.12 mm, and 146.28 ± 33.18 mm away from the adductor tubercle at the anterior, midsagittal axis, and posterior borders of the femur, correspondingly. The popliteal artery was to be located on average 5.40 ± 2.50 mm posterior to the midpoint of the plateau tibia at the joint line. CONCLUSION Considering the mentioned femoral/popliteal artery distances to the femur and proximal tibia would direct surgeons to the safe zones for more accurate surgical approaches in the medial thigh and around the knee when performing osteotomies, knee arthroplasty, arthroscopy, and trauma surgeries, to reduce possible vascular damages. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seyyed-Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed-Mohsen Hosseininejad
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Joint, Bone, Connective Tissue Rheumatology Research Center (JBCRC), Golestan University of Medical Sciences, Gorgan, Iran.
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Rief M, Rief A, Bornemann-Cimenti H, Rief P. Idiopathic pseudoaneurysm of the popliteal artery with endovascular treatment: A case report. Radiol Case Rep 2023; 18:3336-3340. [PMID: 37502134 PMCID: PMC10368536 DOI: 10.1016/j.radcr.2023.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
Popliteal pseudoaneurysms are a rare vascular pathology, usually caused by trauma or iatrogenic interventions. Idiopathic cases are exceptionally uncommon. This case report aims to describe the diagnosis and successful endovascular treatment of an idiopathic pseudoaneurysm of the popliteal artery in a 90-year-old bedridden female patient presented with acute pain and swelling in the left knee at the emergency department. The patient underwent successful endovascular treatment with a covered stent and thrombin injection, leading to complete exclusion of the pseudoaneurysm. Popliteal pseudoaneurysms are a rare pathology, and idiopathic cases are even more uncommon. Endovascular therapy for popliteal pseudoaneurysms is associated with lower morbidity and mortality rates compared to open surgical repair. This case report highlights the importance of interdisciplinary collaboration between vascular surgeons and interventional radiologists in the management of rare vascular pathologies.
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Affiliation(s)
- Martin Rief
- Division of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Angelika Rief
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Helmar Bornemann-Cimenti
- Division of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Peter Rief
- Clinical Department of Angiology, Medical University of Graz, Graz, Austria
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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. Knee Surg Sports Traumatol Arthrosc 2020; 28:1425-1435. [PMID: 31119339 DOI: 10.1007/s00167-019-05515-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
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.
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Darnis A, Villa V, Debette C, Lustig S, Servien E, Neyret P. Vascular injuries during closing-wedge high tibial osteotomy: A cadaveric angiographic study. Orthop Traumatol Surg Res 2014; 100:891-4. [PMID: 25454724 DOI: 10.1016/j.otsr.2014.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 07/13/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION 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. HYPOTHESIS 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. MATERIALS AND 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. DISCUSSION 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. STUDY DESIGN Descriptive cadaver study. Level IV.
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Affiliation(s)
- A Darnis
- 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.
| | - V Villa
- 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
| | - C Debette
- 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
| | - S Lustig
- 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
| | - E Servien
- 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
| | - P Neyret
- 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
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Attinger MC, Behrend H, Jost B. Complete rupture of the popliteal artery complicating high tibial osteotomy. J Orthop 2014; 11:192-6. [PMID: 25561756 DOI: 10.1016/j.jor.2014.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 08/10/2014] [Indexed: 11/28/2022] Open
Abstract
We present two cases of high tibial osteotomies performed at our institution. Both cases were complicated with the immediate postoperative occurrence of an ischaemic syndrome of the lower leg. Urgent diagnostics revealed a complete rupture of the popliteal artery that required re-operation and a vascular repair. Although neurovascular complications during high tibial osteotomies are rare the awareness of this potentially catastrophic complication should be present when performing this common procedure. All precautions to minimize the harm to the neurovascular bundle should be put into practice. A summary of the surgical precautions is presented and discussed in this paper.
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Affiliation(s)
- Marc C Attinger
- Department for Orthopaedic Surgery and Traumatology, University Hospital Berne, 3010 Bern, Switzerland
| | - Henrik Behrend
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
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Oliveira GDP, Guillaumon AT, Brito IBD, Lima JMT, Benvindo SC, Santos LGD. Idiopathic popliteal artery pseudoaneurysm: emergency diagnosis and treatment. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Pseudoaneurysms or false aneurysms of the popliteal artery are uncommon arterial disorders. These disorders most commonly result from trauma and iatrogenic lesions following orthopedic procedures. The authors report a rare case of popliteal artery pseudoaneurysm in which etiology was unknown. The authors also demonstrate that Doppler ultrasonography may be sufficient for planning vascular surgical procedures and that the open surgical approach is the treatment of choice for cases in which the symptomatic lesion causes local compression.
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