Location of the popliteal artery during medial and lateral distal femoral osteotomy: A retrospective study using contrast-enhanced computed tomography-based three-dimensional models.

Abstract

Intraoperative popliteal artery injury during distal femoral osteotomy (DFO) is a fatal complication that requires detailed anatomical examination. We evaluated the location of the popliteal artery in medial and lateral DFO using contrast-enhanced computed tomography (CT)-based three-dimensional (3D) models. This retrospective observational study included 30 knees that underwent contrast-enhanced CT primarily for cardiovascular disease. Osteotomy planes for medial and lateral DFO were created using 3D models. The popliteal artery distance was measured as the distance between two points where the bone and blood vessels were closest to each other, the location of the popliteal artery was determined by dividing the distance from the starting point to the nearest arterial point by the total osteotomy distance, and the angle closest to popliteal artery was defined as the angle formed by three points: the osteotomy starting point and the points near the bone and popliteal artery, in both models. The shortest distance from the artery to the osteotomy line did not differ significantly between the lateral DFO (13.5 ± 3.0 mm) and medial DFO groups (14.2 ± 3.5 mm). The ratio of popliteal artery location was significantly closer to the osteotomy starting point in the lateral DFO group (0.29 ± 0.12) than in the medial DFO group (0.45 ± 0.13) (P < 0.001). The angle closest to the artery was significantly larger in the lateral DFO group (31.1 ± 6.9°) than in the medial DFO group (26.9 ± 7.7°) (P < 0.05). In distal femoral osteotomies, the popliteal artery requires more attention during medial DFO than during lateral DFO.