Popliteal artery injury associated with multiligament knee injuries and tibial plateau fractures: A 20‐year retrospective cohort study

Abstract

Abstract Purpose Popliteal artery injury (PAI) around the knee is a limb‐threatening condition typically associated with high‐energy trauma, particularly multiligament knee injuries (MLKIs) and tibial plateau fractures. This study aimed to analyse injury patterns, management, complications and functional outcomes, with the hypothesis that fracture‐related PAI would be associated with better functional outcomes than MLKI‐associated PAI. Methods A retrospective review was conducted of patients treated for PAI at a tertiary referral centre from 2003 to 2023. Patients were eligible if computed tomography angiography confirmed PAI associated with MLKI or a high‐energy tibial plateau fracture. Demographics, injury characteristics, surgical management and complications were recorded. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) score and visual analogue scale (VAS) for pain. Results Forty‐eight patients (mean age, 44.1 years; 68.7% male) were included: 36 with MLKIs and 12 with fracture‐related vascular injuries. Vascular procedures comprised popliteal bypass grafting in 30 patients (62.5%), venous patch angioplasty in 10 (20.8%) and primary arterial repair in 8 (16.7%). External fixation was applied to all patients. Peroneal nerve injury occurred in 15 patients (31.3%). Amputation was required in five patients (10.4%), all within the MLKI group and was associated with delayed presentation, advanced soft‐tissue compromise and neurovascular injury severity at the time of referral. At final follow‐up, the fracture group had higher IKDC scores (85.4 vs. 74.2; p = 0.032) and lower VAS pain scores (2.39 vs. 3.47; p = 0.049) than the MLKI group. Conclusion In this cohort, fracture‐related PAI was associated with better functional outcomes than MLKI‐associated PAI, whereas all amputations occurred in the MLKI group after delayed presentation and referral. These findings emphasize the importance of timely diagnosis, referral and coordinated vascular–orthopaedic management. Level of Evidence Level III, retrospective comparative study.