Delayed diagnosis of popliteal artery injury after traumatic knee dislocation: a case report

The popliteal artery damage is present to range from 1.6% to 64% of patients with knee dislocation, and it is crucial to evaluate vascular damage even if there are no prominent ischemic changes in the distal area. The injury of the popliteal artery by high-energy forces around the knee caused by a fall or traffic accident is a potentially limb-threatening complication in traumatic knee dislocation. The popliteal artery injury by blunt trauma has a high risk of limb amputation because the initial symptoms can show normal vascular circulation without urgent ischemia or obvious vascular injury signs. Since the collateral branches can delay the symptoms of decisive ischemia or pulseless extremity, the vascular damage is a major cause of limb amputation. In the present study, we describe a rare case of delayed diagnosis of popliteal artery injury after traumatic knee dislocation, requiring urgent limb revascularization surgery. After revascularization of the occluded popliteal artery, graft interposition was performed, and successful restoration was confirmed. This case illustrates that, even if ankle-brachial index >0.9 or equal pedal pulse to the uninjured extremity, serial vascular evaluation is required if there are soft signs such as diminished pulses, neurologic signs, or high-energy damage such as multiple ligament ruptures since delayed diagnosis of artery injury can be the major cause of limb amputation. The clinicians need to regard high-energy trauma such as multiple ligament rupture around the knee as a hard sign, and immediate computed tomography angiography can be helpful for accurate diagnosis and treatment.