Popliteal Artery Injury After Arthroscopic Knee Surgery: A Retrospective Multicenter Cohort Study

Abstract

Objective: Popliteal artery injury is a rare but serious complication of arthroscopic knee surgery. The absence of comprehensive data and standardized guidelines underscores the urgent need for further investigation. This study examines the incidence, risk factors, management strategies, and long-term outcomes of popliteal artery injury in the context of arthroscopic knee procedures.

Methods: We conducted a retrospective cohort study utilizing data from 21 medical institutions in Hunan Province, China, from January 2018 to December 2022. We identified patients who underwent arthroscopic knee surgery and complained of postsurgical popliteal artery injury. Patients were followed up for 43.1 ± 13.23 months (ranging from 22 to 58 months). The primary outcome was joint function, which was evaluated by a postoperative range of motion (ROM), International Knee Documentation Committee (IKDC) scores, Lysholm knee scores, and Visual Vascular Quality of Life Questionnaire (VascuQoL) scores. These data from different postoperative periods were compared via paired t-test to assess postoperative recovery. The secondary outcome was vascular patency of the affected limb, which was evaluated through vascular color Doppler ultrasound.

Results: Among the 17,000 knee arthroscopic procedures analyzed, 10 patients were identified with popliteal artery injury (0.059%). The surgeries performed included arthroscopic cystectomy for popliteal cysts, cruciate ligament reconstruction, and posterior horn of the lateral meniscus repair. Treatments for popliteal artery injury included percutaneous intravascular stent implantation (one patient), direct suture repair (four patients), allograft vascular transplantation (one patient), and reconstruction with an autogenous greater saphenous vein (four patients). After a mean follow-up time of 43.1 ± 13.23 months (ranging from 22 to 58 months), no complications were reported. Compared with patients at 1 month after surgery, patients at 2 years after surgery presented improved knee function and ROM. The average Lysholm score increased significantly from 13.8 ± 4.21 to 68.2 ± 15.50, the IKDC score increased from 11.6 ± 2.46 to 48.1 ± 11.75, and the VascuQoL score improved from 54.8 ± 9.54 to 92.5 ± 15.90. Knee extension improved from 13.3° ± 2.36° to 3.5° ± 4.12°, and knee flexion increased from 49.5° ± 12.57° to 107° ± 21.63°. All patients successfully resumed daily activities postoperatively.

Conclusion: Popliteal artery injury is a catastrophic complication that warrants significant attention during knee arthroscopy. This injury can occur in various types of arthroscopic knee procedures. Prompt diagnosis and effective intervention are crucial for minimizing the potential detriment associated with popliteal artery injury.

Keywords: arthroscopic knee surgery; endovascular treatment; popliteal artery injury.

FIGURE 1

Preoperative imaging results of the patient. (A) Preoperative CTA revealed a popliteal mass measuring approximately 61.4 × 35.9 mm (white arrow). (B) An axial view of the preoperative CTA showed an occupancy of approximately 73.3 × 81.6 mm (yellow arrow). (C) Preoperative MRI showed a clear‐cut mass‐like mixed signal in the popliteal fossa with a cross‐sectional area of approximately 160.1 × 65.8 mm (red arrow). The signal intensity of the PCLR graft is mixed. (D) Color Doppler ultrasound of the lower extremity vessels showed a mixed echogenic mass in the popliteal fossa.

FIGURE 2

Intraoperative photos of this patient. (A) Many black blood clots (yellow arrow) were visible at the incision of the popliteal fossa. (B) An obvious rupture in the middle section of the popliteal artery (black arrow) was visible after the blood clots were removed. (C) After removing the torn popliteal artery, the distal and proximal ends of the popliteal artery (yellow pentagram) were dissected freely. (D) The great saphenous vein (yellow triangle) was grafted over to anastomose the two severed ends.

FIGURE 3

Postoperative CTA showed the patency of blood flow at the site of the great saphenous vein transplantation (yellow arrow).

FIGURE 4

Preoperative imaging results of the patient. (A) Plain radiographs showed the affected knee joint before the reduction of left knee dislocation. (B) MRI indicated injuries to both the lateral collateral ligament (white arrow) and the medial collateral ligament (yellow arrow). (C) MRI showed the disruption of the continuity of the ACL and PCL (white triangle).

FIGURE 5

Imaging results of the patient. (A) DSA showed a ruptured popliteal artery pseudoaneurysm (red arrow). (B) A Viabahn Stent Graft was deployed and ballooned at the broken ends of the popliteal artery. (C) Postoperative CTA showed the patency of blood flow in the left popliteal artery (yellow arrow).