Delayed anterior tibial artery pseudoaneurysm following the corrective fibular osteotomy for knee osteoarthritis - A Case Report

Introduction: Proximal fibula osteotomy (PFO) has been recognized as a surgical alternative for treating medial compartment osteoarthritis of the knee. Related peroneal neuropathies were concerned despite relatively low complications after PFO. In our clinical practice, a modification of the osteotomy level was thus made without mentioned neurologic deficits. However, a rare case of vascular injury was encountered. Herein we present a rare anterior tibial artery (ATA) psuedoaneurysm after this corrective osteotomy. Case presentation: A 55-year-old male visited our emergent room, presenting a painful swelling over his right antero-lateral shin 13 days post PFO. Radiological investigations showed an ATA pseudoaneurysm and which was solved with endovascular repair. Discussion: The suggested osteotomed level of PFO prone the peroneal neuropathies, which could be avoided by the modified level of osteotomy. Despite similar relief of knee pain, a rare case of vascular complication, ATA psuedoaneurysm, was encountered. Considering the course of ATA, the osteotomy should start at the posterolateral corner of the fibula and aim toward the anterior tibia. Conclusion: Although PFO was a simple surgical procedure, not free of complications. Recent surgical history along with alarming vascular symptoms should arouse clinical suspicion and timely intervention.