Xu Zhenmu, Jiang Kai, Chen Yueming, He Hao, Zhu Weihong
Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Orthopaedics, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China.
Orthop Surg. 2025 Mar;17(3):822-830. doi: 10.1111/os.14334. Epub 2024 Dec 30.
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.
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.
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.
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.
腘动脉损伤是膝关节镜手术中一种罕见但严重的并发症。由于缺乏全面的数据和标准化指南，凸显了进一步研究的迫切需求。本研究探讨了膝关节镜手术中腘动脉损伤的发生率、危险因素、治疗策略及长期预后。
我们进行了一项回顾性队列研究，利用来自中国湖南省21家医疗机构2018年1月至2022年12月的数据。我们确定了接受膝关节镜手术并术后出现腘动脉损伤的患者。对患者进行了43.1±13.23个月（22至58个月）的随访。主要结局是关节功能，通过术后活动范围（ROM）、国际膝关节文献委员会（IKDC）评分、Lysholm膝关节评分和视觉血管生活质量问卷（VascuQoL）评分进行评估。通过配对t检验比较不同术后时期的这些数据，以评估术后恢复情况。次要结局是患侧肢体的血管通畅情况，通过血管彩色多普勒超声进行评估。
在分析的17000例膝关节镜手术中，有10例患者被诊断为腘动脉损伤（0.059%）。所进行的手术包括腘窝囊肿的关节镜下囊肿切除术、交叉韧带重建术和外侧半月板后角修复术。腘动脉损伤的治疗方法包括经皮血管内支架植入术（1例患者）、直接缝合修复术（4例患者）、同种异体血管移植术（1例患者）和自体大隐静脉重建术（4例患者）。平均随访时间为43.1±13.23个月（22至58个月），未报告并发症。与术后1个月的患者相比，术后2年的患者膝关节功能和ROM有所改善。Lysholm平均评分从13.8±4.21显著提高到68.2±15.50，IKDC评分从11.6±2.46提高到48.1±11.75，VascuQoL评分从54.8±9.54提高到92.5±15.90。膝关节伸展从13.3°±2.36°改善到3.5°±4.12°，膝关节屈曲从49.5°±12.57°增加到107°±21.63°。所有患者术后均成功恢复日常活动。
腘动脉损伤是一种灾难性并发症，在膝关节镜检查期间值得高度关注。这种损伤可发生在各种类型的膝关节镜手术中。及时诊断和有效干预对于将与腘动脉损伤相关的潜在损害降至最低至关重要。
