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Levy BJ, Sperling K, Davila J, Levy IM. A Novel Case of Recurrent Hemarthrosis Following Knee Arthroscopy in a Patient with Undiagnosed Hemophilia. Arthrosc Sports Med Rehabil 2020; 2:e289-e294. [PMID: 32548594 PMCID: PMC7283926 DOI: 10.1016/j.asmr.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/12/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Benjamin J Levy
- University of Connecticut, Department of Orthopaedic Surgery, UCONN Health, Farmington, Connecticut
| | - Karen Sperling
- Department of Radiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Jennifer Davila
- Department of Pediatrics, Division of Hematology, Albert Einstein College of Medicine, Bronx, New York
| | - I Martin Levy
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Barner KL, Mayer CM, Orth C, Tran QV, Olinger AB, Wright BW. Mapping the genicular arteries to provide a caution zone during knee surgery. Clin Anat 2019; 33:1049-1055. [PMID: 31837179 DOI: 10.1002/ca.23535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Reports from the current literature show a lack of detail with depictions of the genicular arteries (GA). The intricate anatomy and infrequency of operating in the posterior knee may lead to surgeons being unfamiliar with the anatomy. The goal of this cadaveric study was to quantitatively map the arteries and create a caution zone that can be utilized when preparing and performing surgical procedures involving the knee. MATERIALS AND METHODS The left knees of 46 cadavers were used. The distance of the GAs were from the joint line (JL) (+, superior to JL; -, inferior to JL) was measured in two locations: popliteal artery (PA) branch point and medial/lateral knee. The angle the artery traveled between these two points in the posterior knee was measured. A caution map was created. RESULTS The superolateral GA branched from PA at +47.3 mm and traveled superiorly at 57.7° to +52.2 mm at the lateral knee. The superomedial GA branched from PA at +55.2 mm and traveled superiorly at 66.8° to +57.3 mm at the medial knee. The inferolateral GA branched from PA at -0.6 mm. It traveled superiorly at 74.1° or inferiorly at 62.1° to -1.0 mm at the lateral knee. The inferomedial GA branched from the PA at +9.9 mm. It traveled inferiorly at 21.2° to -33 mm at the medial knee. CONCLUSION The GAs have a predictable pattern of location in the knee. There is a mismatch between medical textbooks and reality regarding arterial depictions. Knowledge regarding where the arteries are located may help reduce vascular complications in patients in the future.
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Affiliation(s)
- Kyle L Barner
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Catherine M Mayer
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Charles Orth
- Department of Orthopedic Surgery, North Kansas City Hospital, Kansas City, Missouri
| | - Quoc V Tran
- College of Osteopathic Medicine, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Anthony B Olinger
- Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - Barth W Wright
- Department of Anatomy, Kansas City University of Medicine and Biosciences, Kansas City, Missouri
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Abstract
Recurrent hemarthrosis (RH) is a rare complication (∼1%) after total knee arthroplasty (TKA). It is a complex and particularly frustrating problem for both patient and surgeon. Typically, patients present several months to years after their index TKA surgery with a painful and swollen joint. Although conservative management may provide temporary relief, the rate of recurrence is high. Despite extensive case series in the literature, no consensus was made on the criteria needed to establish this diagnosis, or how to best provide treatment. Several management strategies have been described for RH, including immobilization, arthroscopic versus open synovectomy, angiographic embolization, and revision arthroplasty. All of these have demonstrated variable effectiveness, with limited evidence for their use in specific situations. This review synthesizes the available literature and suggests an algorithm for the diagnosis and treatment of RH after TKA.
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Quantitative analysis of the perimeniscal position of the inferior lateral genicular artery (ILGA): magnetic resonance imaging study. Surg Radiol Anat 2018; 40:823-828. [PMID: 29694643 DOI: 10.1007/s00276-018-2031-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The inferior lateral genicular artery (ILGA) passes around the lateral knee joint, adjacent to the lateral meniscus (LM). ILGA injuries in total knee arthroplasty or arthroscopic surgery can result in recurrent hemarthrosis or painful pseudoaneurysms. Detailed information about the perimeniscal position of the ILGA relative to the LM is necessary to avoid these complications. METHODS 3-T MR images of 100 knees (mean age 36.3 ± 11.2 years) were retrospectively reviewed. The perimeniscal area was divided into four regions: the anterior, middle, popliteal hiatus, and posterior zones. In each zone, the ILGA diameter, superoinferior position (assessed as the height of the ILGA from the LM base), and distance between the meniscocapsular junction and the ILGA were measured. RESULTS The distance between the ILGA and meniscocapsular junction was significantly smaller in the middle zone than in the other three zones (anterior 5.3 ± 0.8 mm, middle 1.4 ± 0.4 mm, popliteal hiatus 6.1 ± 1.0 mm, and posterior 5.6 ± 1.5 mm, p < 0.05). In the superoinferior position, the height of the ILGA was 3.4 ± 0.9 mm in the anterior zone, 0.4 ± 1.3 mm in the middle zone, - 1.9 ± 1.8 mm in the popliteal hiatus zone, and - 1.3 ± 4.3 mm in the posterior zone. When the LM bottom is the base, the ILGA was located superiorly in the anterior zone, close to the base in the middle zone, and inferiorly in the popliteal hiatus zone. CONCLUSIONS To avoid ILGA injury, close attention is necessary during surgical procedures involving the meniscocapsular junction of the LM, especially at the meniscal base in the middle zone.
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de Carvalho RT, Ramos LA, Novaretti JV, Ribeiro LM, Szeles PRDQ, Ingham SJM, Abdalla RJ. Relationship Between the Middle Genicular Artery and the Posterior Structures of the Knee: A Cadaveric Study. Orthop J Sports Med 2017; 4:2325967116673579. [PMID: 28050573 PMCID: PMC5175417 DOI: 10.1177/2325967116673579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The middle genicular artery (MGA) is responsible for the blood supply to the cruciate ligaments and synovial tissue. Traumatic sports injuries and surgical procedures (open and arthroscopic) can cause vascular damage. Little attention has been devoted to establish safe parameters for the MGA. Purpose: To investigate the anatomy of the MGA and its relation to the posterior structures of the knees, mainly the posterior capsule and femoral condyles, and to establish safe parameters to avoid harming the MGA. Study Design: Descriptive laboratory study. Methods: Dissection of the MGA was performed in 16 fresh, unpaired adult human cadaveric knees with no macroscopic degenerative or traumatic changes and no previous surgeries. The specimens were meticulously evaluated with emphasis on preservation of the MGA. The distances from the MGA to the medial and lateral femoral condyles were measured. The Mann-Whitney test was used for statistical analysis. Results: In all specimens, the MGA emerged from the anterior aspect of the popliteal artery, distal to the superior genicular arteries, and had a short distal trajectory toward the posterior capsule where it entered proximal to the oblique popliteal ligament. The artery lay in the midportion between the condyles. The distance between the posterior aspect of the tibia and the point of entry of the MGA into the posterior joint capsule was 23.8 ± 7.3 mm (range, 14.72-35.68 mm). There was no correlation between an individual’s height and the distance of the entrance point of the MGA into the posterior joint capsule to the posterior superior corner of the tibia. Conclusion: The middle genicular artery lies in the midportion between the medial and lateral femoral condyles. Clinical Relevance: This knowledge is important for the preservation of the blood supply during posterior knee surgical procedures and to settle a secure distance between the posterior aspect of the tibia and the MGA input. This could decrease and prevent iatrogenic vascular injury risk to the MGA.
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Affiliation(s)
| | - Leonardo Addêo Ramos
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - João Victor Novaretti
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Leandro Masini Ribeiro
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | | | - Sheila Jean McNeill Ingham
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.; Knee Institute of the Heart Hospital, São Paulo, Brazil.; AACD Rehabilitation Centre, São Paulo, Brazil
| | - Rene Jorge Abdalla
- Department of Orthopaedic Surgery, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.; Knee Institute of the Heart Hospital, São Paulo, Brazil
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Bergen CJAV, Gerards RM, Opdam KTM, Terra MP, Kerkhoffs GMMJ. Diagnosing, planning and evaluating osteochondral ankle defects with imaging modalities. World J Orthop 2015; 6:944-953. [PMID: 26716090 PMCID: PMC4686441 DOI: 10.5312/wjo.v6.i11.944] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/02/2015] [Accepted: 10/13/2015] [Indexed: 02/06/2023] Open
Abstract
This current concepts review outlines the role of different imaging modalities in the diagnosis, preoperative planning, and follow-up of osteochondral ankle defects. An osteochondral ankle defect involves the articular cartilage and subchondral bone (usually of the talus) and is mostly caused by an ankle supination trauma. Conventional radiographs are useful as an initial imaging tool in the diagnostic process, but have only moderate sensitivity for the detection of osteochondral defects. Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate imaging modalities. Recently, ultrasonography and single photon emission CT have been described for the evaluation of osteochondral talar defects. CT is the most valuable modality for assessing the exact location and size of bony lesions. Cartilage and subchondral bone damage can be visualized using MRI, but the defect size tends to be overestimated due to bone edema. CT with the ankle in full plantar flexion has been shown a reliable tool for preoperative planning of the surgical approach. Postoperative imaging is useful for objective assessment of repair tissue or degenerative changes of the ankle joint. Plain radiography, CT and MRI have been used in outcome studies, and different scoring systems are available.
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Filho ES, Isolani GR, Baracho FR, de Oliveira Franco APG, Ridder Bauer LA, Namba M. Pseudoaneurysm after arthroscopic procedure in the knee. Rev Bras Ortop 2015; 50:131-5. [PMID: 26229905 PMCID: PMC4519561 DOI: 10.1016/j.rboe.2015.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/28/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to review all cases of pseudoaneurysm in the literature, in predominantly arthroscopic procedures on the knee, and to report on a case of pseudoaneurysm that we treated. A bibliographic search was conducted for scientific articles published in Brazilian and foreign periodicals over the last 23 years. Forty-seven cases were found, in 40 articles. In addition to these 47 cases, there was the case that we treated, which was also included in the data. Among the operations that progressed with formation of a pseudoaneurysm, 60% were cases of meniscal injuries and 23%, anterior cruciate ligament injuries. In 46% of the cases, the artery affected with the popliteal, and in 21%, the inferomedial genicular artery. The commonest clinical symptom was pain (37%), followed by pulsating tumor (31%), edema of the calf (12%) and hemarthrosis (11%). The median time taken to make the diagnosis was 11 days, but it ranged from one day to 10 weeks after the procedure. Although rare, pseudoaneurysms are a risk that is inherent to arthroscopic surgery. All patients should be made aware of the vascular risks, even in small-scale procedures.
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Affiliation(s)
- Edmar Stieven Filho
- Sports Traumatology and Arthroscopy Center, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Filipe Ribas Baracho
- Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Luiz Antônio Ridder Bauer
- Sports Traumatology and Arthroscopy Center, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Mario Namba
- Sports Traumatology and Arthroscopy Center, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Filho ES, Isolani GR, Baracho FR, Franco APGDO, Bauer LAR, Namba M. Pseudoaneurisma após procedimento artroscópico no joelho. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Geniculate artery embolization for recurrent postarthroplasty hemarthrosis of the knee. Radiol Case Rep 2015; 10:1105. [PMID: 27398122 PMCID: PMC4921181 DOI: 10.2484/rcr.v10i2.1105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hemarthrosis after total knee arthroplasty is an uncommon condition. We present a unique case of recurrent hemarthrosis in a 93-year-old woman two years after an uneventful total knee arthroplasty and describe how we successfully treated her with selective angiographic embolization of the geniculate arteries.
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Alserr AHK, Antonopoulos CN, Papapetrou A, Kakisis JD, Brountzos E, Liapis CD. Endovascular Repair of Popliteal Artery Pseudoaneurysm With Arteriovenous Fistula After Knee Arthroscopy. Vasc Endovascular Surg 2013; 48:166-70. [PMID: 24302163 DOI: 10.1177/1538574413512379] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report a case of postarthroscopic popliteal artery pseudoaneurysm (PSA) with arteriovenous fistula (AVF; PSA-AVF) in a 53-year-old woman who presented with limb edema, pain, and bruit 1 year after arthroscopic meniscectomy. She was treated percutaneously by covered stent deployment. After 6 months of follow-up, the patient was asymptomatic, with patency of the stent and occlusion of the AVF. A review of the literature was also performed to investigate the prevalence of postarthroscopic PSAs and highlight the endovascular approach of treatment. Endovascular approach with covered stent appears to be less invasive and might be an effective and feasible way of treatment of postarthroscopic popliteal PSA-AVF.
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Affiliation(s)
- Ayman H. K. Alserr
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | | | | | - John D. Kakisis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Elias Brountzos
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
| | - Christos D. Liapis
- Department of Vascular Surgery, Attikon University Hospital, Athens, Greece
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Transarterial embolization for the management of hemarthrosis of the knee. Eur J Radiol 2012; 81:2737-40. [DOI: 10.1016/j.ejrad.2011.11.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 11/03/2011] [Accepted: 11/06/2011] [Indexed: 12/29/2022]
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Mello W, de Brito WE, Migon EZ, Borges A. Pseudoaneurysm of the medial inferior genicular artery after anterior cruciate ligament reconstruction. Arthroscopy 2011; 27:442-5. [PMID: 21353173 DOI: 10.1016/j.arthro.2010.10.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Revised: 10/20/2010] [Accepted: 10/29/2010] [Indexed: 02/02/2023]
Abstract
We present a case of pseudoaneurysm formation of the medial inferior genicular artery after anterior cruciate ligament reconstruction. The patient presented with repeated knee hemarthrosis. He was diagnosed by means of magnetic resonance angiography and was treated by means of transluminal embolization. The patient's normal was normal after resolution of the vascular pathologic condition.
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Affiliation(s)
- Wilson Mello
- Instituto Wilson Mello and Pontifícia Universidade Católica de Campinas, Campinas, Brazil.
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