Popliteal artery injury during posterior cruciate ligament reconstruction

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.rboe.2015.04.005

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…Neurovascular injury, although rare, is the most feared complication of PCL reconstruction. Despite the proximity of the neurovascular structures to the PCL, only one case study was found describing a popliteal artery injury during a PCL reconstruction 56. Among the long-term studies evaluating operative management of PCL reconstructions, only three reported on complications of the procedures 25,30,44.…”

Section: Resultsmentioning

confidence: 99%

Optimal management of posterior cruciate ligament injuries: current perspectives

Shelbourne¹,

Benner²,

Ringenberg³

et al. 2017

ORR

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Background:The optimal management of posterior cruciate ligament (PCL) injuries is debated by orthopedic surgeons. A natural history study (NHS) of acute, isolated PCL tears in patients with a mean follow-up of 14.3 years was previously published. The purpose of this study was to compare and contrast the results of the NHS study with those of other studies with similar follow-up time after operative and nonoperative management of isolated PCL tears. Material and methods:With reviewing the literature, six operative management and six nonoperative management studies were found for treating isolated PCL injuries. We analyzed the subjective and objective outcomes of these 12 studies and compared them to the results of the NHS to determine optimal management of PCL injuries. Results: Final follow-up times ranged from a mean of 6.2 to 15 years in the nonoperative studies and 6.3 to 12 years in the operative studies. Side-to-side differences in laxity following surgical management ranged from 1.1 to 7 mm on KT-1000 arthrometer testing and 2.8 to 4.7 mm on Telos stress testing. Tegner scores at final follow-up ranged from 6.6 to 7.7 in nonoperative studies and 5.7 to 7.4 in operative studies. International Knee Documentation Committee scores were 73.4, 82.7, and 84 in nonoperative studies and 65 and 87 in the operative studies. Lysholm scores were 85.2 in the nonoperative study and ranged from 81 to 92.1 in operative studies. Osteoarthritis was reported with ranges from 17% to 88% in nonoperative studies and 13.3% to 63.6% in operative studies. Conclusion: We found that the subjective and objective results in the NHS compare favorably to those of outcomes for PCL reconstruction. Unless a technique is found that can completely restore knee stability, it is unlikely that simply reducing posterior laxity will improve outcomes or prevent the development of osteoarthritis.

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Section: Resultsmentioning

confidence: 99%

Optimal management of posterior cruciate ligament injuries: current perspectives

Shelbourne¹,

Benner²,

Ringenberg³

et al. 2017

ORR

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“…Vascular injury to the popliteal artery is a potential complication during screw fixation of tibial tubercle fractures 4–7. Thus, knowledge of the anatomical variation of the popliteal artery in pediatric patients may provide important insight during tibial tubercle fracture fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Vascular injury to the popliteal artery is a potential complication during screw fixation of tibial tubercle fractures. [4][5][6][7] Thus, knowledge of the anatomical variation of the popliteal artery in pediatric patients may provide important insight during tibial tubercle fracture fixation. We found sagittal measurements to be similar at the proximal 3 levels, averaging 5 cm, and tapering distally, decreasing to a mean width of 4 cm.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

“…Studies have reported on the risk of injury to the popliteal artery during total knee arthroplasty, submuscular plating, proximal tibial osteotomy, and cruciate ligament reconstruction and repair. [4][5][6] However, the current literature on the risk of similar injury during cannulated screw insertion for tibial tubercle fracture has limited sample sizes and measurements to allow adequate mapping of the popliteal artery. [7][8][9] Although intraoperative fluoroscopy is used to ensure proper orientation of the screws in tibial tubercle fracture treatment, vascular injury to the popliteal artery is a potential complication.…”

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confidence: 99%

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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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Preoperative, Intraoperative, and Postoperative Complications With Posterior Cruciate Ligament

Doerre¹,

Warth²,

Floren³

et al. 2019

Complications in Orthopaedics: Sports Medicine

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Popliteal artery injury during posterior cruciate ligament reconstruction

Cited by 3 publications

References 9 publications

Optimal management of posterior cruciate ligament injuries: current perspectives

Optimal management of posterior cruciate ligament injuries: current perspectives

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

Preoperative, Intraoperative, and Postoperative Complications With Posterior Cruciate Ligament

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