Delayed diagnosis of a pseudoaneurysm with recurrent hemarthrosis of the knee joint

Abstract

This is a case report of recurrent hemarthrosis of the knee joint over 3 months. The patient, a 47-year-old male had three arthroscopic procedures with multiple joint punctures over a 3-month-period prior to our initial consultation. The first procedure (arthroscopic synovectomy) was done for suspected infection following a series of hyaluronic acid injections. Recurrent hemarthrosis developed subsequent to this. Upon further evaluation, a pseudoaneurysm of the superior middle genicular artery was detected and successfully treated with selective angiographic embolization.

Mapping the genicular arteries to provide a caution zone during knee surgery

“…Vascular complications from knee surgery are rare ranging from 0.003% to 1% for arthroscopy and 0.03% to 0.2% for total knee arthroplasty (TKA) (Neagoe, Bancu, Muresan, & Sala, 2015;Smith, McGraw, Taylor, & Masri, 2001). However, some authors believe that these numbers may underestimate the incidence of these injuries since numerous case studies have provided evidence for complications regarding the genicular arteries including pseudoaneurysm, fistula formation, and transection in patients undergoing TKA, anterior cruciate ligament (ACL) reconstruction, diagnostic arthroscopy, and meniscectomy (Becher, Burger, Allenberg, Kaufmann, & Thermann, 2008;Guy, Spalding, & Jarvis, 1993;Lamo-Espinosa, Llombart Blanco, & Valentí, 2012;Law, Cheung, Chiu, & Antonio, 2007;Manning & Marshall, 1987;Mello, de Brito, Migon, & Borges, 2011;Milankov, Miljkovic, & Stankovic, 2006;Mufty, Smits, & Feyen, 2011;Pai, 1999;Saini et al, 2013;Vincent & Stanish, 1990). It is also believed that legal implications may play a role in a lower reported incidence of complications (Neagoe et al, 2015).…”

“…Damage to the genicular arteries during surgical procedures have been documented in many case reports, most commonly TKA during release of the lateral retinaculum and medial structures along the proximal tibia, excessive retraction, and excision of the menisci (Pai, 1999;Law et al, 2007;Saini et al, 2013). ovectomy (Becher et al, 2008;Evans, de Boer, Mayor, Rees, & Guy, 2000;Guy et al, 1993;Lamo-Espinosa et al, 2012;Manning & Marshall, 1987;Mello et al, 2011;Milankov et al, 2006;Mufty et al, 2011;Vincent & Stanish, 1990).…”

“…With partial laceration of the artery, a pseudoaneurysm may form which allows blood to dissect and travel into the surrounding tissue through a defect in the arterial wall (Hilborn et al, 1994). Patients may present with pain, recurrent hemarthrosis, neuropraxia from compression of the tibial nerve, deep vein thrombosis by compression of the popliteal vein, pulsating masses and swelling, which can be limb-threatening (Becher et al, 2008;Mansour & Gorsuch, 2007;Mello et al, 2011;Pai, 1999;Saini et al, 2013).…”

Mesenchymal Stem Cells: Potential Role in the Treatment of Osteochondral Lesions of the Ankle

“…[84] Due to its inferior structure, fibrocartilage has been found to breakdown quickly leading to fibrillation and deterioration after only a few years. [85] Due to the vulnerability of fibrocartilage, there is conflicting evidence in the literature on the role of BMS in the repair of OCLA. [86,87] Age, duration of symptoms, and a traumatic aetiology have not been found to influence outcome [88] but superior results seem to be associated with smaller lesions.…”

Pseudoaneurysm after arthroscopic procedure in the knee

“…Forty-seven cases in forty articles were surveyed. 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 In addition, our single case described above was included in the data.…”