PHYSICIANS' RECIPROCAL INSURERS
Risk Management Department
Alert © 2000
Popliteal Artery Injury
May 2000
(Revision of Alert 89:3 of June 1989)
We continue to see cases of injuries to the popliteal artery as
a complication of arthroscopic procedures on the knee joint. Unfortunately,
recognition of this complication has often been delayed, resulting
in severe, permanent disability and even limb loss.
It is imperative that all orthopedic surgeons who perform such
operations recognize the close proximity of the popliteal artery
to the capsule of the knee joint posteriorly and be alert, as
to the possible occurrence of injury to this artery. It is important
to note and record foot and ankle pulses bilaterally both prior
to surgery and postoperatively. Should unusual pain or swelling,
changes in color or temperature of the toes, changes in sensation
or motion of toes or foot, or loss or diminution of foot or ankle
pulses occur, immediate vascular consultation must be obtained.
Often, the popliteal artery should be explored at once without
arteriography which is sometimes misleading and because any delay
is dangerous.
It is important to recognize that collateral circulation may cause
foot and ankle pulses to be faintly present and detectable by
Doppler, even with complete transection of the popliteal artery.
The swelling associated with these injuries does not represent
a simple "compartment syndrome" and obviously should
not be treated by fasciotomy alone.
Although, fortunately, this complication is not common, the possibility
of its occurrence should be discussed with appropriate patients
preoperatively, in obtaining their informed consent.
