Journal of investigative surgery : the official journal of the Academy of Surgical Research · 2026
Prevalence and Impact of Popliteal Artery Injury Associated with Knee Dislocations, Ligament Injuries, and Peri-Knee Fractures: Analysis of the Nationwide Readmission Database, 2016-2020.
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Teng Hsiu-Gwo
Аннотация
BACKGROUND: Severe knee trauma, including knee dislocations, ligament injuries, and peri-knee fractures, carries a risk of popliteal artery injury (PAI). We aimed to evaluate the prevalence and clinical impact of PAI in adult patients sustaining severe knee trauma.
METHODS: This retrospective cohort study included adult inpatients (≥18 years) with peri-knee fracture, knee dislocation, or ligament injury, using data from the United States Nationwide Readmissions Database from 2016 to 2020. Propensity score matching (PSM) was used to balance baseline characteristics. Outcomes included length of stay (LOS), complications, amputations, and 30-day and 90-day unplanned readmissions. Multivariable regression analyses were conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
RESULTS: Among an estimated 211,108 hospitalizations nationwide, the weighted prevalence of PAI was 0.38% (95% CI, 0.33%-0.42%). Knee dislocation was the strongest predictor of PAI. After PSM, PAI was associated with higher risks of any medical complication (aOR 2.56, 95% CI 1.88-3.49), respiratory failure or mechanical ventilation (aOR 3.59, 95% CI 2.15-5.98), acute kidney injury (aOR 2.71, 95% CI 1.76-4.19), and any surgical complication (aOR 4.50, 95% CI 3.40-5.97) as well as increased risk of 30-day unplanned readmission (aOR 1.81, 95% CI 1.21-2.70) and longer LOS (adjusted β 9.15 days, 95% CI 7.57-10.72).
CONCLUSIONS: PAI is associated with substantial morbidity and increased healthcare utilization following severe knee trauma, reinforcing the need for comprehensive vascular assessment, particularly in knee dislocation-related injuries. Given the observational nature of this administrative database study, these associations should not be interpreted as causal.
METHODS: This retrospective cohort study included adult inpatients (≥18 years) with peri-knee fracture, knee dislocation, or ligament injury, using data from the United States Nationwide Readmissions Database from 2016 to 2020. Propensity score matching (PSM) was used to balance baseline characteristics. Outcomes included length of stay (LOS), complications, amputations, and 30-day and 90-day unplanned readmissions. Multivariable regression analyses were conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
RESULTS: Among an estimated 211,108 hospitalizations nationwide, the weighted prevalence of PAI was 0.38% (95% CI, 0.33%-0.42%). Knee dislocation was the strongest predictor of PAI. After PSM, PAI was associated with higher risks of any medical complication (aOR 2.56, 95% CI 1.88-3.49), respiratory failure or mechanical ventilation (aOR 3.59, 95% CI 2.15-5.98), acute kidney injury (aOR 2.71, 95% CI 1.76-4.19), and any surgical complication (aOR 4.50, 95% CI 3.40-5.97) as well as increased risk of 30-day unplanned readmission (aOR 1.81, 95% CI 1.21-2.70) and longer LOS (adjusted β 9.15 days, 95% CI 7.57-10.72).
CONCLUSIONS: PAI is associated with substantial morbidity and increased healthcare utilization following severe knee trauma, reinforcing the need for comprehensive vascular assessment, particularly in knee dislocation-related injuries. Given the observational nature of this administrative database study, these associations should not be interpreted as causal.