Cystic Adventitial Disease of the Popliteal Artery: Elongation into the Media of the Popliteal Artery and Communication with the Knee Joint Capsule: Report of a Case

Cystic disease of the popliteal artery is a rare disorder in which most cases involve the formation of an adventitial cyst that disturbs the popliteal artery blood flow. We present herein the case of a patient presenting with popliteal artery occlusion due to compression by a cyst which formed at the media of the popliteal artery. The onset occurred during a baseball game in which he played catcher. Preoperative magnetic resonance imaging demonstrated a communication of the cyst with the adjacent knee joint. This unusual case could provide important clues to help identify the pathogenesis of this disease. Received: November 26, 1999 / Accepted: May 30, 2000     

Surgical Management of Septic Arthritis of the Knee With a Coexistent Popliteal Cyst

We report a case of knee pyarthrosis in a 54-year-old woman with rheumatoid arthritis and a popliteal cyst. The onset of infection coincided with a cortisone injection. Initial management consisted of arthroscopic irrigation and debridement (I&D) on 2 consecutive occasions without resolution of the infection. Only after open excision of the popliteal cyst in conjunction with I&D of the knee joint proper did the infection resolve. This is the first reported case of a patient requiring excision of a popliteal cyst to clear pyarthrosis of the knee after failure of arthroscopic I&D. Consideration should be given to open debridement or drainage of popliteal cysts in patients who present with septic arthritis in the presence of a popliteal cyst. A treatment algorithm for managing this clinical scenario is presented.     

Arthroscopic Cystectomy for Popliteal Cysts Through the Posteromedial Cystic Portal

In the treatment of patients with popliteal cysts (Baker’s cysts), we generally need to address the intra-articular pathologies, most commonly, medial meniscal tears and concomitant connecting valvular mechanisms responsible for the formation and recurrence of the cyst. We introduce here an arthroscopic technique that can treat the associated intra-articular pathology and correct the valvular mechanism of the capsular fold. The most important step is to locate the opening connection between the joint cavity and the popliteal cyst at the posteromedial compartment. The opening is found at the posteromedial side of the medial head of the gastrocnemius after inferior displacement of the capsular fold, which overlies the opening. It is helpful to rotate the bevel of the arthroscope upward to the 11-, 12-, and 1-o’clock positions for most effective visualization of the capsular fold. After the opening connection of the cyst is found, the capsular fold is resected with basket forceps and a shaver inserted through the posteromedial portal to correct the valvular mechanism. Furthermore, we have developed an additional “posteromedial cystic portal,” which is located directly above the popliteal cyst and can be effectively used in cystectomy, especially in treatment of cysts that consist of septa and nodules. Arthroscopic popliteal cyst removal with use of an additional posteromedial cystic portal can be effective in treating a cyst with multiple fibrous septa or membranes.     

关节镜下内引流联合或不联合囊壁切除治疗腘窝囊肿临床疗效的Meta分析

目的运用Meta分析的方法探讨比较关节镜下内引流联合或不联合囊壁切除两种术式治疗腘窝囊肿的临床疗效。 方法使用计算机检索PubMed、The Cochrane Library、EMBASE、中国知网和万方等数据库,检索时间从2016年08月到2021年08月,检索内容为关节镜下内引流联合或不联合囊壁切除治疗腘窝囊肿的临床对照研究。依据纳入标准及排除标准选取检索文献,然后采用Newcastle Ottawa Scale（NOS）文献质量评价量表及Cochrane手册中偏倚评估标准对纳入文献资料进行质量评估。应用Review Manager5.4软件对汇编的数据结果进行分析,比较关节镜下内引流联合或不联合囊壁切除两种术式治疗腘窝囊肿的临床疗效差异。 结果最终纳入9项研究,共494例患者,其中关节镜下内引流组256例,关节镜下内引流联合囊壁切除组248例。Meta分析结果显示：关节镜下单纯内引流组术后Lysholm评分[MD=-0.49,（95% CI：-2.09,1.11）,P=0.55]、术后Rauschning-Lindgren分级[OR=0.54,（95% CI：0.28,1.04）,P=0.06]及住院时间[MD=-0.29,（95% CI：-0.73,0.14）,P=0.19]均与关节镜下内引流联合囊壁切除组无差异;内引流组术后并发症发生率低于囊壁切除组[OR=0.26,（95% CI：0.10,0.65）,P=0.004],内引流组手术时间[MD=-11.72,（95% CI：-13.69,-9.76）,P<0.01]及手术切口长度[MD=-5.94,（95% CI：-11.05,-0.83）,P=0.02]均短于囊壁切除组,而囊壁切除组术后复发率则低于内引流组[OR=3.32,（95% CI：1.82,6.06）,P<0.01],两者差异有统计学意义。 结论关节镜下内引流联合或不联合囊壁切除治疗腘窝囊肿临床结果都较满意,与关节镜下单纯内引流相比,联合囊壁切除术后复发率更低,但术后并发症的发生率较高、手术时间较长。     

膝关节镜下双后内侧入路治疗腘窝囊肿疗效分析

目的 评价屈曲90°位膝关节镜下双后内侧入路治疗腘窝囊肿的临床疗效。方法 选取我院2017年5月至2020年5月行关节镜手术治疗膝关节腘窝囊肿的30例病人,均于屈曲90°膝关节位行双后内侧入路,刨除后关节囊反折,使单向活瓣变为双向通道,并对囊壁进行清理。通过术后1周内及末次随访时复查的MRI来检验腘窝囊肿的复发情况;通过比较手术前后的Rauschning-Lindgren腘窝囊肿分级标准来评估临床疗效。结果 关节镜探查发现,所有病人都合并关节内损伤,其中大部分为半月板退变性损伤（70%）。平均随访10个月（8~13个月）,术后1周及末次随访时的MRI都未显示囊肿复发;术后1个月和末次随访的Rauschning-Lindgren分级均较术前明显改善,差异有统计学意义（P＜0.05）。结论 屈膝90°位固定,关节镜下双后内侧入路治疗腘窝囊肿,疗效确切,安全可靠。     

Popliteal pseudoaneurysm and arteriovenous fistula after arthroscopic anterior and posterior cruciate ligament reconstruction: A case report

IntroductionVascular injuries are a well recognised but very rare complication of surgery or trauma around the knee, especially associated with arthroscopic anterior and posterior cruciate ligament reconstruction.Presentation of caseThis report describes a case of a Popliteal pseudoaneurysm and arteriovenous fistula after Arthroscopic anterior and Posterior Cruciate Ligament Reconstruction. An 57-year-old male who complained of pain and swelling around the left lower extremity after the ACL and PCL reconstruction using a semitendinosus graft from the two limbs caused by bicycle accident. He was diagnosed with the popliteal pseudoaneurysm and arteriovenous fistula by the Doppler ultrasonographic examination and CTA, and transferred to the interventional radiology suite where a successful vascular stent implantation was made. There was no postoperative complication.DiscussionThe most important finding of the present case were a popliteal pseudoaneurysm and arteriovenous fistula after the ACL and PCL reconstruction. To our knowledge, very few cases reporting an arteriovenous fistula with popliteal pseudoaneurysm following arthroscopy have been described. Vascular injury is a very rare complication of knee surgery, but surgeons should always consider this possibility in patients who have undergone knee arthroscopy. If the patient has symptoms of pain in the popliteal area and unexplainable swelling following arthroscopic ACL and PCL reconstruction, a popliteal vascular injury should be suspected.ConclusionsIn order to minimize the risk of vascular complications in ACL and PCL reconstructive surgery, we advise to look for less traumatizing instruments and to limit the amount of riskful actions, precise attention should be paid in the establishment of the tibial tunnels.     

Popliteal pseudoaneurysm caused by Nora's lesion of the femur in a young child: A rare presentation and first report

Bizarre parosteal osteochondromatous proliferation (BPOP), or Nora's lesion, was first described by Nora et al. in 1983 as a rare, tumor-like lesion involving the bones of the hands and feet. Popliteal artery pseudoaneursyms in the pediatric population are also unusual. Here, we present a case of a young male with a popliteal artery pseudoaneurysm and distal femur lesion originally thought to be an osteochondroma. A 10-year old, Caucasian male was referred to our facility following an MRI concerning for a popliteal artery pseudoaneurysm. On physical exam, there was a palpable 5 × 5-cm pulsatile mass in the upper popliteal fossa with a normal pulse exam bilaterally. A computed tomographic angiogram demonstrated a 4.5-cm by 1.8-cm by 3.6-cm pseudoaneurysm adherent to a 3.5-cm thick, exostotic lesion of the posterior right femur. He was taken to the operating room for repair of the popliteal pseudoaneurysm and resection of his bone lesion. The final pathology was consistent with a popliteal pseudoaneurysm, osteochondroma, and bizarre parosteal osteochondromatous proliferation (BPOP), otherwise known as Nora's lesion. The location of the lesion and the age of our patient were both atypical for BPOP and to our knowledge, this represents the first report of a resulting popliteal artery pseudoaneurysm.     

Osteochondrolipoma Presenting as a Popliteal Cyst

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.     

腘窝囊肿的诊断及治疗进展

腘窝囊肿是一种常见的膝关节周围囊肿,又叫Baker囊肿。随着目前对于腘窝囊肿的研究发现,其发病机制主要是由于各种原因引起的膝关节内压力增高,导致腓肠肌内侧头与半膜肌肌腱滑囊膨出而形成。目前的诊断方法主要有膝关节X线片、超声及MRI。其中,MRI被认为是诊断腘窝囊肿的金标准。治疗方法多种多样,主要有保守治疗、传统手术切除及关节镜手术。近年来,腘窝囊肿的治疗重点逐渐从单纯切除囊肿转变为关节镜下处理关节内病变及对关节腔与囊肿的交通口的处理上,并取得了不错的疗效,但对于最有效的治疗方式仍有争议,仍未确定最佳的手术方式。希望未来可以有高质量的前瞻性研究直接比较不同治疗方式的疗效,从而选择出最佳治疗方式。本文通过回顾过去的文献研究,分别从腘窝囊肿的流行病学、病理机制、临床表现与体征、辅助检查、诊断与鉴别诊断及临床治疗6个方面详细描述。对不同诊断方法及治疗方法进行对比总结,为临床诊疗提供依据。     

Popliteal Artery Pseudoaneurysm Caused by Osteochondroma

A 49-year-old man with asymptomatic osteochondroma was found to have a pseudoaneurysm of the left popliteal artery. An angiography showed a popliteal artery pseudoaneurysm adjacent to a femoral osteochondroma. The osteochondroma was excised and the popliteal artery containing the tear was also excised by end-to-end anastomosis. Vascular complication of osteochondroma is extremely rare. Paul reported the first case of a popliteal artery pseudoaneurysm due to an osteochondroma in 1953. A computerized literature search revealed 40 additional cases reported in English, providing sufficient detail to allow comparison. The average age of the patients was 22.6 years (range: 9-51 years) and most cases identified involved males (30 of 41, 73%). Most pseudoaneurysms were located in the popliteal artery. This report discusses the authors experience with this disorder and a review of the literature in English.     

Pseudoaneurysm complicating knee arthroscopy. A case report

Pseudoaneurysm formation is a rare complication after knee arthroscopy. Most pseudoaneurysms complicating knee arthroscopy develop on the popliteal and geniculate arteries. We report a case of a pseudoaneurysm developed on an arterial branch to the medial gastrocnemius muscle, as a complication of an arthroscopic meniscectomy in a 66-year-old patient. The patient was treated successfully by resection of the pseudoaneurysm and ligation of the injured artery.     

全关节镜下内引流技术治疗腘窝囊肿

目的:对比全关节镜下内引流技术与关节镜联合后方小切口技术治疗腘窝囊肿的临床疗效。方法:2015年1月至2017年1月收治腘窝囊肿患者60例,男29例,女31例,年龄30～65(47.8±2.5)岁,病程(8.5±4.2)个月。其中30例接受全关节镜下内引流技术治疗(全关节镜组),30例接受关节镜联合后方小切口技术治疗(关节镜联合小切口组)。对两组手术时间、术中出血量、切口长度、术后Rauschning和Lindgren分级0级恢复率及膝关节Lysholm评分进行对比。结果:全关节镜组29例和关节镜联合小切口组28例获得随访,时间8～20(12.8±2.1)个月。手术时间:全关节镜组(45.32±5.71) min,关节镜联合小切口组(44.56±3.85) min;术后Rauschning和Lindgren分级0级恢复:全关节镜组23例,关节镜联合小切口组22例;术后膝关节Lysholm评分:全关节镜组84.5±11.2,关节镜联合小切口组83.2±12.7;两组比较差异均无统计学意义(P0.05)。术中出血量:全关节镜组(5.32±1.25) ml,关节镜联合小切口组(20.75±8.18) ml;切口长度:全关节镜组(1.51±0.34) cm,关节镜联合小切口组(7.34±0.75) cm;两组比较差异有统计学意义(P0.05)。两组末次随访均行膝关节MRI检查,无囊肿复发病例。结论:全关节镜下内引流技术与关节镜联合后方小切口技术治疗合并关节内病变腘窝囊肿的临床疗效相当,但创伤更小,术后恢复更快。     

膝关节置换术腘动脉损伤的治疗体会

目的探讨膝关节置换术腘动脉损伤的原因及治疗方法。 方法回顾性分析2010年10月至2018年5月就诊于烟台市烟台山医院的6例膝关节置换术出现腘动脉损伤患者的临床资料,其中5例为腘动脉假性动脉瘤,1例为腘动脉血栓形成,腘动脉假性动脉瘤予以局部压迫、注射凝血酶、腘动脉修补治疗,腘动脉血栓形成予以置管溶栓治疗。 结果1例腘动脉血栓性形成经置管溶栓后动脉血流恢复,5例腘动脉假性动脉瘤经治疗后均消失,其中1例经局部加压,1例经局部注射凝血酶,3例经腘动脉修补治疗。 结论膝关节置换术腘动脉损伤的原因与患者自身基础疾病、血管条件及术中操作等有关,根据患者腘动脉损伤情况选择合适治疗方式可以得到有效的治疗。     

腘窝囊肿切除术中使用曲安奈德对复发的影响

目的 探讨开放性腘窝囊肿切除术中使用醋酸曲安奈德是否可降低囊肿复发率.方法 59例腘窝囊肿患者分为A组（32例）和B组（27例,对照组）,A组囊肿切除后用醋酸曲安奈德液4ml对蒂部、囊壁浸泡5 min,B组囊肿切除后不予醋酸曲安奈德液浸泡处理.术后随访6～24个月,平均14.2个月.若彩色超声检查提示再次出现囊肿,判定为术后复发.卡方检验分析数据示P＜0.05视为有统计学意义.结果 A组患者囊肿复发3例（9.38％）,B组患者复发4例（14.81％）,差异无统计学意义（x2 =0.057,P＞0.05）.结论 开放性腘窝囊肿切除术中局部使用醋酸曲安奈德,不会影响囊肿复发率.     

Association of deep venous thrombosis and popliteal pseudoaneurysm after arthroscopic meniscectomy

Popliteal pseudoaneurysm is an infrequent outcome of closed or penetrating injuries to the popliteal artery. An unusual case of iatrogenic right popliteal pseudoaneurysm in a female patient referred to our attention 20 days after arthroscopic meniscectomy is described.     

Spontaneous Arterial Recanalization with Magnetic Resonance Angiography Evidence: Report of a Case

A 27-year-old man was admitted to our hospital for investigation of severe claudication in his right foot. Based on the findings of magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), we diagnosed anatomic popliteal artery entrapment syndrome, which was causing a short popliteal artery occlusion. Moreover, a long posterior tibial artery occlusion and a peroneal artery lesion had developed as distal thromboembolic complications of the entrapment. Thus, we planned to perform in situ vein bypass graft for the popliteal occlusion and start thrombolytic treatment for the posterior tibial and peroneal lesions. While contemplating the operation, the patient showed a gradual clinical improvement over the next 2 months. A second MRA showed total arterial recanalization of the right posterior tibial and peroneal arteries, although the popliteal artery was still occluded. Spontaneous lower limb arterial recanalization is a rare phenomenon. To our knowledge, this is the first case of spontaneous arterial recanalization after a distal thromboembolic event caused by popliteal entrapment syndrome.     

Popliteal pseudoaneurysm following total knee arthroplasty

Arterial injuries complicating total knee arthroplasty are rare but may result in significant morbidity. There are three reports of popliteal artery pseudoaneurysm resulting from arterial trauma during total knee replacement. We report a case of a popliteal pseudoaneurysm with rupture into the surrounding muscle, its evaluation, and successful repair 5 months after arthroplasty.     

Popliteal pseudoaneurysm caused by stent fracture

Stent fracture with pseudoaneurysm formation in the femoropopliteal artery has uncommonly been reported. We present the case of a 72-year-old man with a fracture of self-expanding nitinol stent and a pseudoaneurysm formation in the suprageniculate popliteal artery. The popliteal artery was successfully reconstructed with a small saphenous vein graft interposition.     

关节镜下经关节腔入路治疗成人腘窝囊肿

目的 探讨关节镜下经关节腔入路治疗成人胭窝囊肿的方法及临床疗效.方法 2004年10月至2006年10月,采用关节镜下经关节腔入路治疗成人腘窝囊肿15例.男5例,女10例;年龄45～60岁,平均50.5岁.胭窝囊肿均为单侧,其中右膝8例,左膝7例,术前均行MR检查,观察胭窝囊肿与膝关节腔是否相通.术中在扩大腓肠肌一半膜肌滑囊与关节腔后内侧室裂隙样结构的同时,处理关节腔内病变,全部手术均在关节镜下完成,并根据Rausohning和Lindgren评价方法评定手术效果.结果 术中发现15例胭窝囊肿患者均伴有不同程度的膝关节内病变,其中内侧半月板撕裂6例,外侧半月板撕裂3例,骨关节炎9例(4例合并内侧半月板撕裂,2例合并外侧半月板损伤),类风湿关节炎2例,前十字韧带损伤1例.术中及术后未出现重要血管和神经损伤.随访时间12～48个月,平均18.5个月,术后14例未出现囊肿复发.Rauschning和Lindgren评价方法:术前,Ⅰ级1例,Ⅱ级5例,Ⅲ级9例;术后,0级13例,Ⅰ级1例,Ⅱ级1例.随访结果满意.结论 成人腘窝囊肿是一种继发性疾病,治疗胭窝囊肿的同时应处理关节内的病变.关节镜下经关节腔入路治疗成人胭窝囊肿,具有创伤小、恢复快、复发率低、并发症发生率低等优点.     

关节镜下治疗腘窝囊肿的疗效

目的 探讨关节镜下切除腘窝囊肿的手术方法与疗效.方法 自2013年1月至2014年2月我科采用关节镜下切除25例腘窝囊肿,腘窝囊肿均为单膝,左膝13例、右膝12例.其中,男10例,女15例,年龄为40~65岁.术前常规体检、患膝X线和MRI检查,观察膝关节骨与软组织的病变.膝关节镜手术常规采用前内、前外侧入路,术中常规探查并清理膝关节内病变.评价病人并发症、疼痛、复发情况,采用Lysholm膝关节评分、美国膝关节协会评分(knee society score,KSS)、美国特种外科医院(Hospi-tal for Special Surgery,HSS)评分比较病人术前术后的情况.结果 25例病人均获得随访,随访时间为6~12个月,平均为(9.0±1.9)个月.复查MRI发现1例类风湿性膝关节炎病人腘窝囊肿复发,但无明显临床症状.术前Lysholm膝关节评分为(48.76±12.07)分,术后术后末次随访为(81.72±7.57)分;术前KSS为(52.32±11.16)分,术后末次随访为(85.84±6.85)分;术前HSS评分为(55.62±10.76)分,术后末次随访为(88.64±6.24)分.3个指标术后与术前比较,差异均有统计学意义(均P<0.05).结论 关节镜下打开内侧关节囊与腘窝囊肿之间的"阀门"并切除囊壁,可以达到治疗腘窝囊肿的目的.本研究手术方法简单有效、安全性高,并可同时处理腘窝囊肿的诱发因素,有效地降低囊肿的复发率.