Popliteal Artery Injury Risk in Total Knee Arthroplasty Related to Anatomic Variations: A Scoping Review

Area of Science:

• Vascular Surgery
• Orthopedic Surgery
• Anatomy

Background:

• Popliteal artery (PA) injury during total knee arthroplasty (TKA) is rare but can cause severe complications.
• Anatomical variations, like high PA bifurcation or aberrant anterior tibial artery (ATA), increase the risk of vascular injury.
• Preoperative identification of these variants is crucial for reducing surgical complications.

Purpose of the Study:

• To assess the prevalence of PA anatomical variants.
• To evaluate the relevance of these variants to TKA.
• To identify associated vascular complications and hypothesize that aberrant arterial anatomy increases risk.

Main Methods:

• A systematic literature search was performed in EMBASE, MEDLINE, and Scopus.
• Studies were screened for relevance to PA variation, prevalence, or TKA-associated vascular complications.
• Data extraction focused on anatomical findings, imaging, and surgical outcomes, adhering to PRISMA-ScR guidelines.

Main Results:

• 11 studies met inclusion criteria, including 4 case reports of vascular injury during TKA in patients with aberrant PA anatomy.
• Aberrant ATA prevalence ranged from 0.4% to 6% in imaging studies, with a 3.2% prevalence found in one MRI study.
• High PA bifurcations and variant ATA origins were identified as risk factors, with increased injury risk noted in women.

Conclusions:

• Popliteal artery anatomical variations may be an underrecognized risk factor for vascular injury during TKA.
• Awareness of anatomical variations, coupled with careful review of MRIs and selective vascular imaging, can improve surgical planning.
• Proactive identification and management of PA anomalies can help mitigate serious postoperative complications.