Journal List > J Korean Orthop Assoc > v.50(5) > 1013404

TOOLS
Lim, Kim, and Kim: Delayed Onset of the Popliteal Artery Pseudoaneurysm Following Medial Opening Wedge High Tibial Osteotomy
Case Report

Journal of the Korean Orthopaedic Association 2015; 50(5): 418-423.

Published online: 23 October 2015

DOI: https://doi.org/10.4055/jkoa.2015.50.5.418

Delayed Onset of the Popliteal Artery Pseudoaneurysm Following Medial Opening Wedge High Tibial Osteotomy

Hae-Seong Lim, M.D., Sang-Min Kim, M.D., Chong-Kwan Kim, M.D.

Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Correspondence to: Sang-Min Kim, M.D. Department of Orthopedic Surgery, Samsung Changwon Hospital, 158 Paryong-ro, Masanhoewon-gu, Changwon 51353, Korea. TEL: +82-55-290-6030, FAX: +82-55-290-6888, heavystone75@gmail.com

Received 24 November 2014       Revised 23 February 2015       Accepted 24 February 2015

Copyright © 2015 by The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

High tibial osteotomy is an established method in treatment of medial knee osteoarthritis with varus deformity in younger patients. The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following medial opening wedge high tibial osteotomy is rare. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery near the osteotomy site. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. We report on the case of a pseudoaneurysm of the popliteal artery complicating medial opening wedge high tibial osteotomy that was treated clinically and radio-graphically with literature reviews.

Keywords: popliteal artery, pseudoaneurysm, genu varum, angiography, osteotomy

Figures and Tables

Figure 1

Preoperative magnetic resonance imaging. (A) A longitudinal horizontal tear is present from body to posterior horn. (B) A radial tear is present at the posterior horn of the lateral meniscus.

jkoa-50-418-g001
Figure 2

Pre- and postoperative scenography. (A) The femorotibial angle measured 8° on the right and 5.8° on the left of anatomical varus. (B) Postoperative standing radiographs showing satisfactory correction of the varus deformity.

jkoa-50-418-g002
Figure 3

Preoperative radiographs of both knees. The Rosenberg view of both knees shows mild gonarthrosis of both knees. PA, posterioranterior.

jkoa-50-418-g003
Figure 4

Postoperative radiographs of both knees. Preoperative varus gonarthrosis is well corrected by open wedge high tibial osteotomy fixed with an anatomical plate.

jkoa-50-418-g004
Figure 5

Lower extremity nonenhanced computed tomography. Approximately 6-cm-sized, ill-defined round isodense mass like lesion at the soleus muscle area of the proximal tibia level.

jkoa-50-418-g005
Figure 6

(A) Femoral angiography study showing a pseudoaneurysm (11.5×8.5-cm-sized) from the popliteal artery with the neck just near the lateral end of the osteotomy site. (B, C) Femoral angiography shows complete obliteration of the pseudoaneurysm after placing a stent in the popliteal artery.

jkoa-50-418-g006
Figure 7

Lower extremity angio-computed tomography (CT). One month after stent implantation. Follow-up CT image demonstrates improvement of pseudoaneurysm.

jkoa-50-418-g007
Figure 8

Intraoperative C-arm fluoroscopy. Radiolucent hohmann retractor protects the popliteal artery.

jkoa-50-418-g008

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

References

1. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br. 1961; 43:746–751.
2. Coventry MB. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am. 1973; 55:23–48.
3. Shin YS, Lee DH, Lee SH, Kim MJ, Han SB. Basic principles and current trends of medial opening-wedge high tibial osteotomy. J Korean Orthop Assoc. 2014; 49:85–94.
4. van Dorp KB, Breugem SJ, Driessen MJ. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction. Knee Surg Relat Res. 2014; 26:187–189.
5. Shenoy PM, Oh HK, Choi JY, et al. Pseudoaneurysm of the popliteal artery complicating medial opening wedge high tibial osteotomy. Orthopedics. 2009; 32:442.
6. Shin YS, Hwang YG, Savale AP, Han SB. Popliteal artery pseudoaneurysm following primary total knee arthroplasty. Knee Surg Relat Res. 2014; 26:117–120.
7. Lee GC, Kim DH, Park SH. Popliteal artery pseudoaneurysm after anterior cruciate ligament re-revision using a rigidfix cross pin. Knee Surg Relat Res. 2014; 26:121–124.
8. Tejero-Garcia S, Lirola Criado JF, Ast MP, Fernandez de. Popliteal pseudoaneurysm after unicompartmental knee replacement: a case report. Knee. 2014; 21:597–599.
9. Kim J, Allaire R, Harner CD. Vascular safety during high tibial osteotomy: a cadaveric angiographic study. Am J Sports Med. 2010; 38:810–815.
TOOLS
Similar articles