Anatomic Relationship Of the Popliteal Vessels In Open Wedge Osteotomy

Open wedge High tibial osteotomy (OWHTO) is a common surgical Procedure that is utilized to correct knee varus deformity and prevent development or advancement of medial compatment knee osteoarthritis.

By turning the mechanical weight-bearing axis to the lateral side it correct lower limb alignment,decrease medial compartment load,pain,arthritic changes, postpone the need for arthroplasty and allow cartilage regeneration.

Like any other surgical procedure (OWHTO) has its own complications.injury to the popliteal vessels (PV) is catastrophic and limb threatening compliation that had been reported with prevalence rate ranging from 0.4% to 1.7% PV runs close to the posterior tibial cortex it might be injured while taking osteotomy cut. To avoid this problem many studies with different tools done to define PV position and its relations to provide safe technique for osteotomy.

(OWHTO) has different methods: Monoplanar and Biplanar osteotomy are most popular,both techniques differ in cut level and shape.

In this study the investigators compare between the two methods (Monoplanar VS Biplanar) concerning their proximity and safety to the PV .

Our hypothesis is that there is increase in the distance between the PV and the posterior tibial cortex the more distal the osteotomy level.

Previous studies cadaveric or preoperative studies provide useful informations with some different results , to the best of our knowledge postoperative studies rarely reported in this subject , the investigators hope this study could provide valuable informations,recommend safer technique and improve surgical outcomes from this procedure.

Inclusion criteria

• age 30-60
• BMI less than 40
• isolated medial compartment OA
• mild to moderate degree OA Grade 2 to 3 according to kellgren&Lawrence classification
• near normal lateral and patellofemoral compartment
• intact lateral meniscus
• varus malalignment less than 15 degree
• functional range of motion

Exclusion criteria

• inflammatory arthritis
• post traumatic arthritis
• patients with previous peripheral arterial injury
• disease or prior insertion of metallic stent in the PV
• patient allergic to contrast agent
• patient with renal impairement
• Patients who refuse to participate in the study
• Patients who are not available for follow up