Clinical anatomy of the popliteal artery and its implications in total knee arthroplasty: a systematic review and meta-analysis.

Abstract

The popliteal artery (PA) is a lower extremity arterial vessel, a continuation of the superficial femoral artery. The PA may be injured in the majority of total knee arthroplasties (TKA), as well as arthroscopic surgeries, which may lead to acute ischaemic injury. Our objective was to analyse the morphometry of the PA in relation to other structures both in flexion and extension of the knee, highlighting discrepancies in the PA's location in varying positions. Literature was reviewed, and morphological qualities, prevalence rates, and variants of PA were pooled. Five cadaveric and 14 radiological studies were included, totalling 1473 lower limbs. We found that the PA, when nearing bone, was more predictable and fixed, as seen in axial plane one and two centimetres distal to the joint line at 0 degrees flexion. The distance between the PA and the posterior tibial cortex was estimated at 3.3 mm with 95% confidence interval (CI) 2.6-4.1 and 7.8 mm (95% CI 5.1-10.5), respectively. Once the PA passed over and near the joint it had greater discrepancies with distance comparing the knee in 0- vs. 90-degree flexion. Due to the rise of TKA, arthroscopic surgeries, and connected vascular complications, the PA has been investigated more frequently, and while the majority of publications describe the relationships between vessels of the popliteal area and specific landmarks conducted with the knee in extension, our study also implemented data regarding knee flexion, thus encompassing the problem in a more dynamic manner. We believe this provides superior data for identification of PA, especially during knee surgery.