PMC5299179_01
Plain radiology of right knee (25th of May 2016 @ 13:03).
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Plain radiography of the right knee (Figure 1) identified a small quantity of fluid in the suprapatellar recess with lateral joint space increase and medial tibial plateau irregularity, in keeping with a relocated lateral fracture dislocation of the patellofemoral joint with avulsion fracturing of the anteromedial tibial plateau.
CT peripheral angiogram (25th of May 2016 @ 15:37), 3D reconstruction, posterior view displaying normal vasculature on left, and occlusion to right popliteal artery.
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Following administration of an intravenous heparin bolus (5000 international units), a CT angiogram [CTA] as shown in Figure 2 was performed to delineate the arterial vascular pathology and confirm deep venous patency in addition to bony injuries.
Intraoperative image of right popliteal artery demonstrating thrombus burden (a) and intimal distraction injury (b).
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A longitudinal arteriotomy was performed over the area and extended into healthy vessel in both directions (2 cm each).  Figure 3 demonstrates the intraoperative finding of an intimal distraction injury over 1.5 cm length with a central thrombus burden.
Postoperative MRI assessing multiligamentous disruption showing popliteal vessel patency and patch repair.
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fig4
Subsequent MRI of the knees (Figure 4) identified on the left a complete ACL tear and medial collateral ligament.