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What is the Optimal Treatment Protocol for Traumatic Popliteal Artery Injury? A Comparative Study between Two
Sadaki Mitsuzawa1, Shinnosuke Yamashita1, Yoshihiro Tsukamoto1
1Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
Introduction:
While rare, popliteal artery injury is a potentially devastating complication of knee trauma. Delayed diagnosis or inadequate management of popliteal artery injury can result in limb ischemia, amputation, and long-term disability. This study aimed to compare the treatment outcomes of popliteal artery injury between different medical centers and to reconsider the optimal protocol at our institution.
Methods:
Medical records of patients sustaining traumatic popliteal artery injury from 2011 to 2022 at two institutions (one hospital: Group A; the other hospital: Group B) were retrospectively reviewed. Demographic data, radiological assessment, time course and content of initial treatment, clinical outcomes, and follow-up period were recorded.
Results:
Group A included seven patients (dislocations, n = 3; fractures, n = 2; and glass penetration injuries, n = 2), with a mean follow-up period of 39 months. Group B included five patients (dislocations, n = 3 and fractures, n = 2), with a mean follow-up period of 36 months. Two patients in Group A and four patients in Group B exhibited contrast-medium resumption (average deficit: 57 mm and 60 mm, respectively). The time from injury to reperfusion was significantly shorter in Group A than in Group B (300 min vs. 749 min, P < 0.05). Group A underwent four temporary vascular shunting procedures, four external fixations, six fasciotomies, and five bypass grafting procedures. In Group B, temporary vascular shunt (TVS) was not used in any patient; however, three, two, and three patients underwent external fixation, fasciotomy, and bypass grafting, respectively. One patient in each group required above-the-knee amputation. The mean Lysholm score was 80.4 points in Group A and 72.0 points in Group B.
Conclusions:
TVS considerably reduces the reperfusion time. Various options for the content and sequence of treatment must be carefully considered in advance. Early diagnosis, prompt intervention, and comprehensive management can improve the quality of care and patient outcomes.
