Lesão da artéria poplítea durante a reconstrução do ligamento cruzado posterior

Cenni, Marcos Henrique Frauendorf; Nascimento, Bruno Fajardo do; Carneiro, Guilherme Galvão Barreto; Andrade, Rodrigo Cristiano de; Júnior, Lúcio Flávio Biondi Pinheiro; Nicolai, Oscar Pinheiro

doi:10.1016/j.rbo.2014.06.013

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…It then descends through the fossa obliquely until it bifurcates into the anterior and posterior tibial arteries at the posterior‐inferior‐lateral aspect of the fossa. At the level of the joint line, several studies have shown the artery to be either midline or slightly lateral to the midline, near the posterior horn of the lateral meniscus [ 7 , 13 , 17 , 26 ]. In the popliteal fossa, the artery is fairly mobile, surrounded by fat and loose connective tissue.…”

Section: Introductionmentioning

confidence: 99%

Measured distance from posterior tibia to popliteal artery increases with flexion and subluxation of the knee

Hungerford,

Pichard‐encina,

Boner

et al. 2024

J. exp. orthop.

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PurposePopliteal artery laceration is a devastating complication in total knee arthroplasty (TKA). Its anatomic position relative to the tibia has been studied using ultrasound or magnetic resonance imaging. This is the first study performed in a laboratory using radiographic measurements to determine if increased flexion and subluxation of the knee increase the distance between the tibia and popliteal artery.MethodsThe femoral artery was infused with radiopaque dye in six cadavers. The knee was placed in two different degrees of flexion and three of subluxation. The radiographic distance between standardized markers in the posterior tibia and popliteal artery was measured.ResultsThe average distance from the tibial peg to the popliteal artery at 90° of flexion increased from 0% to 50% to 100% subluxation. The increase was statistically significant (Friedman test p = 0.016). The contrast between neutral and 100% subluxation was statistically significant (Sign test p = 0.031). At 115° flexion, average distance from the peg to popliteal artery significantly increased as subluxation increased (Friedman test p = 0.05). In three specimens, at 115° of flexion and 100% subluxation, a line perpendicular to the axis of the tibia, failed to intersect the popliteal artery. The measured distance increased from 90° to 115° of flexion at a given degree of subluxation, but this difference did not reach statistical significance.ConclusionsIncreasing flexion and subluxation of the tibia results in increasing distance between the cut plane of the tibial plateau and popliteal artery and decreases risk of laceration.Level of EvidenceNot applicable.

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Section: Introductionmentioning

confidence: 99%

Measured distance from posterior tibia to popliteal artery increases with flexion and subluxation of the knee

Hungerford,

Pichard‐encina,

Boner

et al. 2024

J. exp. orthop.

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The presence of an aberrant anterior tibial artery does not depend on the patient's morphotype

Schuster,

Mayer,

Cornacchini

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aberrant anterior tibial artery (ATA) runs along the posterior surface of the tibial cortex making it, particularly, at risk during high tibial osteotomy (HTO). This study aimed to analyze the prevalence of the ATA according to global morphotype and its anatomical features in consideration of knee surgery.MethodsThis retrospective study included 1589 knees on magnetic resonance imaging (MRI) studies with long‐leg radiographs. The anatomical characteristics of the ATA, its distance in surgical areas at risk and its lumen were defined on MRI. Its presence according to the patient's morphotype (varus, valgus or neutral) was assessed using a χ2 test.ResultsThe ATA was present in 33 of 1589 knees, resulting in a prevalence of 2.1%. The anteroposterior distance of the ATA to the tibial head was 6.6 ± 2.5 mm at the height of the tibial plateau, 2.7 ± 1.6 mm at the footprint of the posterior cruciate ligament and 1.0 ± 0.6 mm under the top of the fibula (p < 0.01). For these three levels, the ratio between the distance from the ATA to the lateral tibial border and the total tibial width decreases progressively (p < 0.001). The mean lumen area of the ATA was 4.2 ± 2.5 mm2, and the lumen of the popliteal artery was 9.2 ± 3.6 mm2, representing a ratio of 49.4 ± 27.0%. The prevalence of ATA was similar between varus and valgus patients (n.s).ConclusionThe presence of an ATA is rare, found in one out of 50 cases, but can be easily identified on MRI in patients before knee surgery, especially before HTO. The patient's morphotype did not influence its presence, the lumen diameter is highly variable and its clinical impact has yet to be determined.Study DesignCross‐sectional study.Level of EvidenceLevel 3.

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Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee

Mun

Suresh

Marrache

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Displaced pediatric tibial tubercle fractures are commonly stabilized with screws directed posteriorly toward neurovascular structures. Here, we (1) characterize the variation of the popliteal artery among pediatric patients; and (2) recommend a safe screw trajectory for fixation of tibial tubercle fractures. Methods: We retrospectively identified 42 patients (42 knees; 29 female) aged 12-17 years with lower-extremity magnetic resonance imaging (MRI) at a tertiary academic center. The mean patient age was 14.5 (range: 12-17) years, and the mean body mass index value was 19.1 (range: 14.9-25.1). We included patients with open physes or visible physeal scars and excluded those with prior instrumentation or lower-extremity injury. Using sagittal MRI, we measured the distances from 5 levels each on the anterior and posterior tibial cortex to the popliteal artery (level 1, midpoint of proximal tibial epiphysis; level 2, the proximal extent of the tubercle; level 3, tubercle prominence; level 4, 2 cm distal to the proximal extent of the tubercle; level 5, 4 cm distal to the proximal extent of the tubercle). Using coronal MRI, we measured the width of the tibia at each level and the distance from the lateral-most and medial-most cortex to the artery. Results: The popliteal artery was laterally positioned in all knees. The mean distance between the artery and lateral-most aspect of the tibia at each level ranged from 1.9 to 2.4 cm, and from 2.3 to 3.9 cm from the medial-most aspect of the tibia. The mean distance that a screw can advance before vascular injury was 5.1 cm at level 1. The shortest mean distance to the popliteal artery was 1.7 cm, at level 5. There is minimal distance between the posterior tibial cortex and the artery at all levels. Conclusions: Understanding the position of the popliteal artery in pediatric patients can help when stabilizing tibial tubercle fractures. Because the artery is close to the posterior cortex, a drill exiting in line with the popliteal artery risks vascular injury. Therefore, we recommend that screws exit within the medial 60% of the tibia.

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Lesão da artéria poplítea durante a reconstrução do ligamento cruzado posterior

Cited by 3 publications

References 8 publications

Measured distance from posterior tibia to popliteal artery increases with flexion and subluxation of the knee

Measured distance from posterior tibia to popliteal artery increases with flexion and subluxation of the knee

The presence of an aberrant anterior tibial artery does not depend on the patient's morphotype

Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee

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