Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

Abstract

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

Mapping the genicular arteries to provide a caution zone during knee surgery

“…Vascular complications from knee surgery are rare ranging from 0.003% to 1% for arthroscopy and 0.03% to 0.2% for total knee arthroplasty (TKA) (Neagoe, Bancu, Muresan, & Sala, 2015;Smith, McGraw, Taylor, & Masri, 2001). However, some authors believe that these numbers may underestimate the incidence of these injuries since numerous case studies have provided evidence for complications regarding the genicular arteries including pseudoaneurysm, fistula formation, and transection in patients undergoing TKA, anterior cruciate ligament (ACL) reconstruction, diagnostic arthroscopy, and meniscectomy (Becher, Burger, Allenberg, Kaufmann, & Thermann, 2008;Guy, Spalding, & Jarvis, 1993;Lamo-Espinosa, Llombart Blanco, & Valentí, 2012;Law, Cheung, Chiu, & Antonio, 2007;Manning & Marshall, 1987;Mello, de Brito, Migon, & Borges, 2011;Milankov, Miljkovic, & Stankovic, 2006;Mufty, Smits, & Feyen, 2011;Pai, 1999;Saini et al, 2013;Vincent & Stanish, 1990). It is also believed that legal implications may play a role in a lower reported incidence of complications (Neagoe et al, 2015).…”

“…Damage to the genicular arteries during surgical procedures have been documented in many case reports, most commonly TKA during release of the lateral retinaculum and medial structures along the proximal tibia, excessive retraction, and excision of the menisci (Pai, 1999;Law et al, 2007;Saini et al, 2013). ovectomy (Becher et al, 2008;Evans, de Boer, Mayor, Rees, & Guy, 2000;Guy et al, 1993;Lamo-Espinosa et al, 2012;Manning & Marshall, 1987;Mello et al, 2011;Milankov et al, 2006;Mufty et al, 2011;Vincent & Stanish, 1990).…”

The role of interventional radiology in the treatment of lower limb vascular injuries after orthopaedic surgery

“…In this scenario, different types of vascular complications have been reported in medical literature, mainly in the form of case reports: vessel laceration, haemorrhage, vascular compression, intimal flap tear, pseudoaneurysm, arteriovenous aneurysm, arterial thromboembolism, and ligation [4][5][6][7][8][9][10][11][12][13][14]20].…”

“…In the literature this scenario has been reported mainly in the form of case reports concerning vascular complications of a specific orthopaedic intervention [4][5][6][7][8][9][10][11][12][13][14]; this paper aims to evaluate the safety and efficacy of endovascular embolisation in a series of patients presenting with arterial injuries of the lower limbs following orthopaedic surgery.…”

Pseudoaneurysm of the articular branch of the descending genicular artery following double-bundle anterior cruciate ligament reconstruction

“…If treatment with ultrasonographyguided compression is ineffective, embolization with a microcatheter should be considered a suitable treatment. Lateral inferior genicular artery Anterolateral portal [9,25] Embolization with microcoils Ligation of the feeding vessel Lateral joint-line stab incisions [13] Ligation of the feeding vessel Medial superior genicular artery Medial portal [16] Ligation of the feeding artery Anteromedial portal [12] Glue embolization…”