Search

Purpose: The purpose of this study was to examine the location where the femoral artery contacts the vastus medialis at the adductor tendon hiatus, which is important when using the subvastus approach in medial closed wedge distal femoral osteotomy. We evaluated the correlation between differences in height, vastus medialis morphology, and lower limb alignment. Methods: Sixty knees (16 male, 44 female) that underwent plain computer tomography (CT) were included. Using the radiographic hip‐knee‐ankle (HKA) angle as a reference, the knees were divided into three groups of 20 knees: valgus, varus, and neutral. The mechanical lateral distal femoral angle (mLDFA) and distance from the medial femoral epicondyle to the centre of the femoral head (D1) were measured on full‐length weight‐bearing anteroposterior radiographs. The first cross‐section on CT where the vastus medialis muscle and femoral artery connect was defined as the cross‐sectional image for measurement. The direct distance from the medial epicondyle to the measured cross‐sectional image (D2) was measured in the coronal view. The ratio of the vastus medialis muscle width to the femoral posterior wall width was defined as the vastus medialis muscle coverage ratio (CR). Correlations between each measurement and group were evaluated. Results: There was a positive correlation between D1 and D2 in the overall, neutral, and varus groups; however, there was no correlation in the valgus group. A positive correlation was observed in terms of the relationship between CR and D2 in the overall and valgus groups. In addition, there was no statistically significant difference in the correlation between the mLDFA and D2, with patient height as a control variable overall and in all groups. Conclusion: In the valgus group, distance to the adductor hiatus was correlated with vastus medialis coverage. Overhang of the vastus medialis may be an important influencing factor of femoral and popliteus artery position. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study was to evaluate the morphology of the distal medial femoral surface during coronal osteotomy in medial closed wedge distal femoral varus osteotomy (MCWDFO) using plain CT., Methods: Twenty knees (mean age, 55.3 years) were included. Preoperative CT images were obtained prior to MCWDFO for valgus OA. In the cross-section depicting the starting position of the transverse cut, a curve was drawn that passed through the centre of the femoral cortex, and lines parallel and perpendicular to the surgical epicondylar axis (SEA) were drawn to analyse the medial side. Inflection points on the medial line were defined as P1-P4. The radii of circles passing through P1-P3 (PR, posterior radius) and P2-P4 (AR, anterior radius) were drawn. Values for the PR, AR, and radius ratio (PR/AR) were measured., Results: Based on the PR/AR, the cross-sectional morphologies were classified into 5 triangular types (PR/AR < 0.5), 4 flat types (PR/AR > 0.8), and 11 convex types (PR/AR 0.6 to 0.7)., Conclusion: The medial anteroposterior width and flange thickness were easier to assess in the flat type; however, these were difficult to assess in the triangular type with a gentle anterior slope. Surgeons should consider the differences in the anterior slope according to cross-sectional morphologies when performing coronal osteotomy in MCWDFO., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)