Frey Christopher, Bugarinovic George, Zhou Joanne, Sherman Seth, Abrams Geoffrey, Segovia Nicole, Cheah Jonathan W
Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA.
Department of Orthopaedic Surgery, Santa Clara Valley Medical Center, San Jose, California, USA.
Orthop J Sports Med. 2024 Dec 19;12(12):23259671241301461. doi: 10.1177/23259671241301461. eCollection 2024 Dec.
Injury to the posterior vasculature is a potential complication in orthopaedic knee surgery that may be associated with variations in its anatomy, such as the type II-A2 variant, which places the anterior tibial artery (ATA) in closer proximity to the tibia. However, how close surgical instrumentation comes to injuring the ATA is not well described.
To determine how the type II-A2 variant of the popliteal vasculature affects proximity of the ATA to instrumentation for orthopaedic knee procedures.
Cross-sectional study; Level of evidence, 3.
A total of 222 knee magnetic resonance imaging (MRI) scans from a single academic tertiary referral center were evaluated, and ATA branching patterns were characterized. The distances from the ATA to simulated instrumentation of high tibial osteotomy (HTO), posterolateral corner anatomic reconstruction, posterior cruciate ligament (PCL) reconstruction, lateral meniscus posterior horn repair, and lateral meniscus posterior root repair on axial plane MRI scans were measured by 2 authors independently using imaging software. Intrarater and interrater reliability of the measurements was calculated using the intraclass correlation coefficient.
ATAs with the type II-A2 pattern passed anterior to the popliteus on 3.15% (n = 7) of the 222 MRI scans. The distance between the ATA and the simulated instrumentation was significantly closer in type II-A2 compared with normal (type I) knees for the lateral meniscus posterior root repair tunnel (11.1 vs 15.7 mm; = .014), HTO cuts (0.6 vs 8.2 mm; < .001), and PCL reconstruction tunnel (4.1 vs 11.7 mm; < .001). Interrater reliability was good to excellent for all measurements, and intrarater reliability ranged from moderate to excellent.
HTO cut, PCL reconstruction tunnel, and lateral meniscus posterior root tunnel instrumentation were significantly closer to the ATA in knees with type II-A2 anatomy compared with normal (type I) anatomy. Careful analysis of vasculature using MRI may be of utility for select surgery about the knee to guide surgical technique.
后血管损伤是骨科膝关节手术中的一种潜在并发症，可能与解剖结构变异有关，如II - A2型变异，该变异使胫前动脉（ATA）更靠近胫骨。然而，手术器械距离ATA多近会造成损伤尚无详细描述。
确定腘血管的II - A2型变异如何影响ATA在骨科膝关节手术中与器械的接近程度。
横断面研究；证据等级，3级。
对来自一个单一学术三级转诊中心的222例膝关节磁共振成像（MRI）扫描进行评估，并对ATA分支模式进行特征描述。由2位作者独立使用成像软件在轴向平面MRI扫描上测量ATA与模拟的高位胫骨截骨术（HTO）、后外侧角解剖重建、后交叉韧带（PCL）重建、外侧半月板后角修复及外侧半月板后根修复器械之间的距离。使用组内相关系数计算测量值的组内和组间可靠性。
在222例MRI扫描中，3.15%（n = 7）的扫描显示具有II - A2型模式的ATA走行于腘肌前方。对于外侧半月板后根修复隧道（11.1对15.7 mm；P = 0.014）、HTO截骨（0.6对8.2 mm；P < 0.001）和PCL重建隧道（4.1对11.7 mm；P < 0.001），II - A2型膝关节中ATA与模拟器械之间的距离明显比正常（I型）膝关节更近。所有测量的组间可靠性良好至优秀，组内可靠性从中度到优秀。
与正常（I型）解剖结构相比，具有II - A2型解剖结构的膝关节中，HTO截骨、PCL重建隧道及外侧半月板后根隧道器械距离ATA明显更近。使用MRI仔细分析血管情况可能有助于指导膝关节特定手术的手术技术。
