Posterior Cruciate Ligament Reconstruction and Vascular Injury: A Case of Popliteal Artery Transection

Injury to the popliteal artery during posterior cruciate ligament (PCL) reconstruction is an uncommon but potentially limb-threatening complication. Given the anatomical proximity of the PCL to the neurovascular bundle, such injuries warrant prompt recognition and intervention. PCL injuries are commonly treated with arthroscopic reconstruction using tibial and femoral tunnels. The proximity of the tibial tunnel to the popliteal artery poses a risk of vascular injury, especially during tunnel reaming or guidewire placement. A 24-year-old male with a history of a fall from a construction site accident was referred to Gandhi Hospital. He was diagnosed with left knee dislocation, which was managed with manipulative reduction and plaster support. Physical examination revealed positive results for the anterior drawer, posterior drawer, and Lachman tests. A plain radiograph revealed significant posterior displacement of the knee joint. The popliteal artery lies close to the posterior tibial cortex and is at risk during PCL reconstruction, particularly with the transtibial tunnel technique. The popliteal artery was lacerated intraoperatively, likely due to overreaming of the posterior cortex or guide pin overpenetration. The use of a tourniquet may delay recognition of bleeding and ischemia. Immediate vascular surgical repair – most often by vein graft interposition or end-to-end anastomosis – is essential to restore limb perfusion and prevent complications such as compartment syndrome or limb loss.