ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1510

 

Varus Mechanism Is Associated with High Incidence of Popliteal Artery Lesions in Multiligament Knee Injuries

Maximiliano Scheu, MD, MMSc, Santiago CHILE
Luis A. O'Connell, MD, Santiago, Colina CHILE
Pedro Díaz Allende, MD, Rancagua, O´Higgins CHILE
Alan Garín, MD, Santiago CHILE
Carolina Mellado, MD, Santiago CHILE
Gonzalo Espinoza, MD, Vitacura, Santiago CHILE

Mutual de Seguridad CChC, Santiago, CHILE

FDA Status Not Applicable

Summary

Significant varus knee instability in the acute setting should increase awareness for popliteal artery injury.

Abstract

Popliteal injuries can be a devastating complication in multiligament knee injuries. Approach to diagnosis is widely variable and clinical signs of ischemia can be insufficient to rule out vascular injuries The aim of this study is to assess the incidence of popliteal artery injuries and correlate them with ligament tears and multiligament injury classification in order to identify high-risk patterns of vascular injury

Method

Retrospective study of a case series with diagnosis of multiligament knee injury between 2012 and 2016 in a Level I Trauma Center. We included patients with 2 or more torn ligaments as shown by Magnetic Resonance Imaging (MRI). Computed tomography angiography (CTA) was obtained routinely as a part of a diagnosis protocol in the presence of gross instability during initial workup. Patient with follow up less than 3 months and without the aforementioned studies were excluded. Data regarding ligament tear was obtained from MRI (1.5 Tesla) by a musculoskeletal radiologist. Injuries were classified according to Schenck’s classification (1994). Demographic data was collected from medical record. Odds Ratio was used to establish association between imaging parameters and vascular injuries. Significant p value was set at 0.05. Statistical analysis was performed using STATA (StataCorp LP. STATA v12)

Results

33 knees (32 patients) were included in the analysis. 31 were men with an average age of 41 (range 18-82). 6 knees (18%) had a popliteal artery injury. Anterior cruciate ligament (ACL) was the most frequently torn (91%) followed by posterior cruciate ligament (PCL) ( 85%), posterolateral corner (PLC) (55%) and medial collateral ligament (MCL) (45%). Regarding Schenck’s classification, type III was found in 73% (IIIL 40%, IIIM 33%), type I in 18% and type II, IV and V accounted for the remaining 9%. The likelihood of having vascular injury was increased 11 times when having a type IIIL dislocation, compared any other injury pattern (p=0.02). No significant association was found between isolated ligament tear and vascular injury This data suggests that varus forces causing enough distraction of the lateral compartment of the knee to tear Posterolateral structures as well as both cruciate ligaments can independently be related to popliteal artery injuries

Conclusion

A multiligamentous knee injury involving PLC, ACL and PCL is related with significant increase in the incidence of popliteal artery injury. This finding should increase awareness for vascular injuries whenever detecting gross varus instability