Associated injury-guided management of traumatic popliteal artery injury: impact on limb salvage and staged reconstruction

Traumatic popliteal artery injury (PAI) associated with periarticular knee trauma is a limb-threatening condition that requires rapid revascularization and coordinated management of concomitant orthopedic injuries. We evaluated the outcomes of an associated injury-based treatment strategy designed to optimize revascularization while facilitating staged definitive reconstruction.

This retrospective single-center case series included 17 patients with traumatic PAI treated between 2013 and 2024 using an associated injury-guided management framework. The strategy guided selection of revascularization approach and surgical sequencing to minimize interference with subsequent orthopedic procedures. Primary outcomes were limb salvage, completion of planned definitive reconstruction, and clinically significant coronal instability requiring additional ligament reconstruction after acute-phase management. Secondary outcomes included knee range of motion (ROM), numeric rating scale (NRS) pain score, and knee injury and osteoarthritis outcome score (KOOS).

Limb salvage was achieved in 16 of 17 limbs (94.1%). In all salvaged limbs, planned staged orthopedic reconstruction was successfully completed. No cases required additional ligament reconstruction during follow-up, and no clinically significant coronal instability was identified. At a mean follow-up of 3.6 years, mean knee ROM was 135.6°, and mean NRS pain score was 0.7. KOOS subscores were presented as descriptive functional outcomes after limb salvage.

An associated injury–based treatment strategy for traumatic PAI may facilitate safe revascularization while supporting staged orthopedic reconstruction. Early multidisciplinary planning that integrates vascular and orthopedic considerations may contribute to limb salvage and acceptable functional recovery in complex periarticular knee trauma.