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Teissier V, Tresson P, Gaudric J, Davaine JM, Scemama C, Raux M, Chiche L, Koskas F. Importance of Early Diagnosis and Care in Knee Dislocations Associated with Vascular Injuries. Ann Vasc Surg 2019; 61:238-245. [PMID: 31344468 DOI: 10.1016/j.avsg.2019.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Arterial injury secondary to acute knee dislocation (KD) is a rare but devastative complication. The aim of this study is to evaluate functional sequelae and factors of poor prognosis. METHODS A retrospective monocentric series of consecutive KD with acute ischemia by popliteal artery injury was analyzed between 2005 and 2017. The main outcome was the amputation rate. RESULTS Sixteen dislocations were included. Nine (56%) were due to public road accidents, 5 (31%) were due to falls from height, and 2 (13%) were due to sports injuries. Dislocation had occurred in the posterior location in 8 (50%) cases. Regarding arterial injury, there were 7 (44%) ruptures, 7 (44%) dissections, and 2 (13%) isolated thromboses. Eleven (69%) KDs with vascular trauma were associated with signs of acute ischemia. Revascularization was achieved by anatomical venous bypass in 14 (88%), resection and direct anastomosis in one (6%), and isolated thrombectomy in one (6%). Median time to surgery (time between trauma and vascular repair) was 7 hours (3.25-60.92 hours). Primary revascularization was performed in 12 (75%) cases. In three cases (19%), orthopedic reduction and stabilization were performed first. In one case, (6%) three-step management with vascular shunt at first, then with knee stabilization, and finally vascular bypass was carried out. Stabilization was achieved by using an external fixator in 13 (82%) cases, by open reduction and internal fixation in one case (6%), by ligamentoplasty in one (6%), and by using a long leg cast in one (6%). Fasciotomy was required in 12 (75%) cases. Two patients had early vascular complications, and 2 had early systemic complications. Three secondary transfemoral amputations were performed. Median follow-up duration was 23 months. No secondary amputation was recorded. At the end of follow-up, functional outcomes were evaluated using the Oxford Knee Score (OKS). The median OKS was 30 versus the pretrauma median OKS of 47 (P < 0.00028). No risk factor associated with limb amputation has been highlighted. CONCLUSIONS Analysis of these results provided indications for therapeutic management of this condition. This study shows poor functional outcomes because of severity of vascular lesion in patients with orthopedic trauma but with healthy arteries.
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Affiliation(s)
- Victoria Teissier
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
| | - Philippe Tresson
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France.
| | - Julien Gaudric
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
| | - Jean-Michel Davaine
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
| | - Caroline Scemama
- Department of Orthopaedic Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
| | - Mathieu Raux
- Sorbonne Université, INSERM, UMRS1158, Neurophysiologie respiratoire expérimentale et clinique, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département d'Anesthésie Réanimation, Paris, France
| | - Laurent Chiche
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
| | - Fabien Koskas
- Department of Vascular Surgery, Groupe Hospitalier Pitié-Salpétrière Charles Foix, APHP, Université Paris6, Paris, France
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Popliteal lesion due to traction during unicompartmental knee revision surgery. J Orthop 2014; 10:38-40. [PMID: 24403746 DOI: 10.1016/j.jor.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 01/01/2013] [Indexed: 11/22/2022] Open
Abstract
Popliteal artery injury is a rare but known complication in knee surgery. Only one article in current literature reports that the risk increases during revision knee surgery. A new case is described in which an injury to the popliteal artery occurred during lateral unicompartmental to total knee arthroplasty revision surgery. This vascular injury occurred 5-10 cm below the tibial resection level in a healthy patient with a history of cruris fracture with plate osteosynthesis and lateral unicompartmental knee arthroplasty. This paper stresses the importance of being aware that trauma and surgery can create fibrosis in which the popliteal artery can get fixated, thus reducing the scope for safe manipulation of the knee during secondary surgery.
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Abstract
Failure to recognize popliteal artery injury and restore vessel continuity of flow after blunt trauma is a major cause of lower extremity amputation and morbidity. A high index of suspicion and early recognition of the injury are paramount for limb salvage. We experienced a rare case of poplitial artery occlusion with the presence of arterial pulses due to collateral circulation after blunt trauma. Expeditious revascularization was achieved by using posterior approach, allowing two surgical teams to work simultaneously. This case illustrates that, even in the absence of knee dislocation, surgeons must always consider the possibility of a popliteal artery damage whenever a blunt trauma near the knee.
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Affiliation(s)
- Jong-Woo Kim
- Department of Thoracic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Chang-Meen Sung
- Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Se-Hyun Cho
- Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, College of Medicine, Gyeongsang National University, Jinju, Korea
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Filis KA, Arko FR, Bakoyannis CN, Georgopoulos SE, Bramis J, Bastounis EA. Spontaneous arterial recanalization with magnetic resonance angiography evidence: report of a case. Surg Today 2006; 36:923-6. [PMID: 16998688 DOI: 10.1007/s00595-006-3245-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 03/14/2006] [Indexed: 10/24/2022]
Abstract
A 27-year-old man was admitted to our hospital for investigation of severe claudication in his right foot. Based on the findings of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), we diagnosed anatomic popliteal artery entrapment syndrome, which was causing a short popliteal artery occlusion. Moreover, a long posterior tibial artery occlusion and a peroneal artery lesion had developed as distal thromboembolic complications of the entrapment. Thus, we planned to perform in situ vein bypass graft for the popliteal occlusion and start thrombolytic treatment for the posterior tibial and peroneal lesions. While contemplating the operation, the patient showed a gradual clinical improvement over the next 2 months. A second MRA showed total arterial recanalization of the right posterior tibial and peroneal arteries, although the popliteal artery was still occluded. Spontaneous lower limb arterial recanalization is a rare phenomenon. To our knowledge, this is the first case of spontaneous arterial recanalization after a distal thromboembolic event caused by popliteal entrapment syndrome.
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Affiliation(s)
- Konstantinos A Filis
- Division of Vascular Surgery, First Department of Surgery, University of Athens Medical School, 3, Tsigante str., 15669 Papagos, Athens, Greece
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Menzoian JO, Raffetto JD, Gram CH, Aquino M. Vascular Trauma. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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