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Articles by C. D. Harner
Total Records ( 2 ) for C. D. Harner
  J Kim , R Allaire and C. D. Harner
  Background

High tibial osteotomy is technically demanding. Risks include injury to the popliteal neurovascular bundle. The present goal was to further define this risk.

Hypothesis

The distance from the posterior tibia to the popliteal artery increases with increasing knee flexion. A saw angle perpendicular to the coronal plane can injure the popliteal artery.

Study Design

Descriptive laboratory study.

Methods

Seven fresh-frozen cadaveric lower extremities were used. Lateral radiographs at knee flexion angles of 90°, 60°, 45°, 30°, and 0° were taken to measure the distance from the anterior border of the popliteal artery to the posterior cortex of the tibia 5.0 mm and 2.0 cm below the joint line. After an opening wedge high tibial osteotomy was made, qualitative assessments were made of the depth of a saw blade inserted into the kerf and the relative encroachment of the saw blade on the popliteal artery. The interval through which the space anterior to the popliteus can be accessed was identified by gross dissection in all specimens.

Results

The distance from the posterior tibia to the popliteal artery increased with knee flexion. At 5.0 mm and 2.0 cm below the joint line, the mean distance at 90° was significantly greater than at all other angles. The popliteal artery could be injured by the oscillating saw at angles greater than 30° to the coronal plane. A protective device inserted anterior to the popliteus protects the neurovascular structures.

Conclusion

The popliteal artery is farthest from the posterior tibia at 90° of knee flexion. Saw angles greater than 30° from the coronal plane put the popliteal neurovasculature at risk of injury.

Clinical Relevance

To perform a safe osteotomy, the knee should be positioned in 90° of flexion with the saw angled less than 30° from the coronal plane. A protective device deep to the popliteus may protect against popliteal injury.

  V Musahl , S. S Jordan , A. C Colvin , M. J Tranovich , J. J Irrgang and C. D. Harner
  Purpose

The purpose of the study was to compare frequency of meniscal repair to partial meniscectomy in patients undergoing anterior cruciate ligament reconstruction using the American Board of Orthopaedic Surgeons (ABOS) database.

Hypotheses

(1) Practice patterns are similar with respect to geographic region. (2) Surgeons with fellowship training perform more meniscal repairs compared with general orthopaedic practitioners. (3) Younger patients are more likely to be treated with meniscal repair at the time of anterior cruciate ligament reconstruction. (4) The frequency of meniscal repair in conjunction with anterior cruciate ligament reconstruction has increased over time.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Information was extracted from the ABOS database from 2002 orthopaedic surgeons who sat for the part II examination from 2003 to 2007. The database was queried for all patients who underwent anterior cruciate ligament reconstruction (Current Procedural Terminology [CPT] code 29888) without or with meniscectomy (CPT 29881) or meniscal repair (CPT 29882). Factors affecting meniscal surgery that were investigated included patient age, geographic region of practice, fellowship training, and declared subspecialty of the surgeon.

Results

On average there were 52 000 cases per year registered in the ABOS database, approximately 1700 of whom underwent anterior cruciate ligament reconstruction. Meniscal repair was most frequently performed in the Southwest region (18.6%, P < .001) and least frequently in the Northwest region (11.3%, P < .001). Combined anterior cruciate ligament reconstruction and meniscal repair was performed significantly more often by fellowship-trained surgeons (17%) than by surgeons with other fellowship training (12%) or no fellowship training (12%, P < .001) and in patients younger than age 25 years (19%) compared with those age 40 years and older (8%, P <.001). Meniscal repair was performed in 13.9% of anterior cruciate ligament reconstructions in 2003 and in 16.4% of anterior cruciate ligament reconstructions in 2007 (P > .05).

Conclusion

Combined anterior cruciate ligament reconstruction with meniscal repair was more frequent for younger patients and by surgeons with sports fellowship training. Concomitant meniscal repair is performed by fellowship-trained surgeons in this study in only 18% of anterior cruciate ligament reconstructions.

 
 
 
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