Managing Popliteal Artery Injury During Orthopedic Surgery: An Evidence-Based Approach

Objectives: Popliteal artery injuries (PAIs), though rare, are serious complications of orthopedic procedures involving the knee, such as total knee arthroplasty (TKA), high tibial osteotomy, and trauma-related surgeries. This review aims to evaluate anatomical and clinical risk factors, diagnostic modalities, and management strategies for PAIs to support improved surgical outcomes. Methods: A narrative review was conducted by analyzing articles published in the last 10 years from PubMed, Scopus, and EMBASE databases. Search terms included “popliteal artery injury,” “knee surgery,” “vascular complications,” and “orthopedic vascular trauma.” Studies addressing incidence, anatomical considerations, risk stratification, diagnostic tools, and treatment approaches for PAIs in the context of knee procedures were included. Results: The reviewed literature reports a PAI incidence ranging from 0.03% to 0.51%, with higher risk in revision surgeries and patients with comorbidities such as peripheral artery disease, obesity, or advanced age. Anatomical proximity of the popliteal artery to the surgical field increases vulnerability to direct trauma, traction, or compression. Clinical presentations include dissection, thrombosis, or transection, often leading to acute limb ischemia. Imaging modalities like Doppler ultrasonography, computed tomography angiography (CTA), and magnetic resonance angiography (MRA) are essential for prompt diagnosis. Surgical and hybrid endovascular interventions have demonstrated efficacy in restoring perfusion and minimizing morbidity. Conclusion: Accurate risk assessment, vigilant surgical technique, and timely vascular evaluation are critical for reducing PAI-related complications. Integrating contemporary imaging and revascularization strategies enhances limb preservation and improves outcomes in complex knee surgeries.