{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T21:14:11Z","timestamp":1779311651011,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T00:00:00Z","timestamp":1652486400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T00:00:00Z","timestamp":1652486400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T00:00:00Z","timestamp":1652486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>This study evaluated major vascular injury risk in distal femoral osteotomy (DFO) via the subvastus approach and examined the relationship between the posterior border of the vastus medialis (VM) and the superficial femoral artery (SFA) and vein (SFV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty limbs from 80 patients were evaluated using lower extremity computed tomographic venography. The positional relationship between the VM, SFA, and SFV was evaluated by measuring the angle between each structure and the horizontal reference point (VMA: VM angle, FAA (femoral arterial angle), FVA (femoral venous angle) and the distance between VM and the SFA and SFV (VMAD: VM\u2010arterial distance, VMVD: VM\u2010venous distance) in each axial slice (0\/10\/20\/30\/40\u00a0mm) proximal to the level of the superior patellar margin. The proximity of the posterior border of the VM and the SFA\/SFV as a vertical distance, measured between the slice of the superior border of the patella and the slice where the posterior border of the VM contacted the SFA was evaluated. Single and multiple regression analyses were performed using the vertical distance as the objective variable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>As the slice shifted proximally, the VMA significantly increased (24.9\u2009\u00b1\u20098.5, 36.3\u2009\u00b1\u20098.8, 47.4\u2009\u00b1\u200911.8, 59.9\u2009\u00b1\u200914, 70.3\u2009\u00b1\u200913.7 degrees, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 between all slices) and moved posteromedially from a medial direction. FAA (94.2\u2009\u00b1\u20097, 86.9\u2009\u00b1\u20099.2, 78.4\u2009\u00b1\u20099.7, 71.4\u2009\u00b1\u20099.8, 66.6\u2009\u00b1\u200910.5 degree, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 between all slices) and FVA (100.6\u2009\u00b1\u20094.9, 98.3\u2009\u00b1\u20095.9, 93.7\u2009\u00b1\u20097.5, 88\u2009\u00b1\u20099.2, 81.1\u2009\u00b1\u200910.5 degrees, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 between all slices) decreased and moved from a posterolateral to a posteromedial direction, while VMAD (35.4\u2009\u00b1\u20097.8, 24.1\u2009\u00b1\u20097.3, 14.3\u2009\u00b1\u20096, 8.4\u2009\u00b1\u20097, 6.2\u2009\u00b1\u20096.3\u00a0mm, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 between all slices) and VMVD significantly decreased (42.7\u2009\u00b1\u20097.3, 32\u2009\u00b1\u20097.4, 22.4\u2009\u00b1\u20096.8, 14.5\u2009\u00b1\u200910.6, 8.7\u2009\u00b1\u20097.1\u00a0mm, respectively, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 between all slices). The average vertical distance was 36\u2009\u00b1\u20099.3\u00a0mm (range 18.6\u201361.5\u00a0mm). The body height and the patellar length significantly affected the vertical distance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The posterior border of the VM shifted posteromedially from distal to proximal and contacted the SFA at an average of 36\u00a0mm from the suprapatellar border. Surgeons should be aware of the risk of major vascular injury during exposure and osteotomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Case series, Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06996-3","type":"journal-article","created":{"date-parts":[[2022,5,14]],"date-time":"2022-05-14T08:10:21Z","timestamp":1652515821000},"page":"1556-1562","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Anatomical implications of the subvastus approach on major vascular injury during a distal femoral osteotomy: a computed tomographic venography study"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1146-3476","authenticated-orcid":false,"given":"Keiji","family":"Tensho","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daiki","family":"Kumaki","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoya","family":"Iwaasa","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suguru","family":"Koyama","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Shimodaira","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shota","family":"Ikegami","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Rehabilitation Shinshu University Hospital 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Horiuchi","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Department of Rehabilitation Shinshu University Hospital 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinori","family":"Tsukahara","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Radiology Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Takahashi","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopedic Surgery Shinshu University School of Medicine 3\u201026\u20101, Asahi, Matsumoto 390\u20108621 Nagano Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,5,14]]},"reference":[{"key":"e_1_2_11_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010017\u20102804\u2010x"},{"key":"e_1_2_11_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010014\u20104007\u2010x"},{"key":"e_1_2_11_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005515\u20101"},{"key":"e_1_2_11_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2014.07.021"},{"key":"e_1_2_11_6_2","doi-asserted-by":"publisher","DOI":"10.1177\/2309499018762616"},{"key":"e_1_2_11_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276\u2010010\u20100658\u20109"},{"key":"e_1_2_11_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2019.02.005"},{"key":"e_1_2_11_9_2","doi-asserted-by":"crossref","unstructured":"FernerF LutterC SchubertI SchenkeM StreckerW DickschasJPerioperative complications in osteotomies around the knee: a study in 858 cases.Arch Orthop Trauma Surg(2021)10.1007\/s00402\u2010020\u201003696\u2010w33417020","DOI":"10.1007\/s00402-020-03696-w"},{"key":"e_1_2_11_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.08.032"},{"key":"e_1_2_11_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010019\u201005439\u2010w"},{"key":"e_1_2_11_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510363664"},{"key":"e_1_2_11_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010013\u20102503\u20102"},{"key":"e_1_2_11_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010020\u201003300\u20107"},{"key":"e_1_2_11_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00590\u2010020\u201002648\u20109"},{"key":"e_1_2_11_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2021.02.016"},{"key":"e_1_2_11_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.12.012"},{"key":"e_1_2_11_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00276\u2010002\u20100004\u2010y"},{"key":"e_1_2_11_19_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010020\u201005988\u20105"},{"key":"e_1_2_11_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2020.09.010"},{"key":"e_1_2_11_21_2","first-page":"435","volume-title":"Anatomic exposures in vascular surgery","author":"Valentine RJ","year":"2021"},{"key":"e_1_2_11_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40634\u2010016\u20100042\u20108"},{"key":"e_1_2_11_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167\u2010012\u20102133\u20100"},{"key":"e_1_2_11_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1753193410364484"}],"container-title":["Knee Surgery, Sports Traumatology, Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-022-06996-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00167-022-06996-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00167-022-06996-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1007\/s00167-022-06996-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T14:33:58Z","timestamp":1760884438000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1007\/s00167-022-06996-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,14]]},"references-count":23,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1007\/s00167-022-06996-3"],"URL":"https:\/\/doi.org\/10.1007\/s00167-022-06996-3","archive":["Portico"],"relation":{},"ISSN":["0942-2056","1433-7347"],"issn-type":[{"value":"0942-2056","type":"print"},{"value":"1433-7347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,14]]},"assertion":[{"value":"20 January 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The author(s) declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Shinshu University (July 27th, 2020\/ No. 4804).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The documentation of informed consent was waived by the Institutional Review Board because of the retrospective nature of the study and the analysis used anonymous clinical data. We disclosed the information on conducting the study to the research subjects, guaranteed an opportunity to refuse to conduct or continue the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}