Management of knee arthropathy in patients with vascular malformations.
OBJECTIVE
To describe our experience with surgical intervention for symptomatic intraarticular vascular malformations of the knee in patients with peripheral vascular malformations including Klippel-Trénaunay syndrome (KTS).


METHODS
Eleven patients underwent surgical intervention for symptomatic intraarticular vascular malformations of the knee between 1987 and 2008. Seven patients had KTS, and 4 patients had venous malformations. Surgical indications, imaging studies, clinical course, surgical procedures, complications, and follow-up visits were reviewed and recorded.


RESULTS
A total of 11 patients (8 males; 3 females; mean age, 11.7 years; range, 2.5-23 years) underwent 12 surgical procedures. Five patients had an amputation, and 6 patients had knee synovectomies. One patient had bilateral knee synovectomies. Surgical indications included pain, swelling, limited mobility, and/or loss of knee motion. The average time of follow-up was 54 months (range, 7-109 months). Patient-reported pain scores decreased significantly from a mean of 2.9 +/- 1.4 preoperatively to 1.3 +/- 0.9 postoperatively (P = 0.01).


CONCLUSIONS
When necessary, surgical intervention for intraarticular vascular malformations of the knee (amputation or synovectomy) may be effective in decreasing pain and improving mobility in patients with peripheral vascular malformations. It is possible that early synovectomy may slow or prevent the rapid destructive arthritis that occurs in these knees. Surgeons and patients should anticipate complications related to bleeding from vascular malformations. We recommend a multidisciplinary approach to the patient with KTS, particularly when surgical intervention is indicated.
Johnson
Jonathan N
JN
Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Shaughnessy
William J
WJ
Stans
Anthony A
AA
Unruh
Kenneth P
KP
Sim
Franklin H
FH
McIntosh
Amy L
AL
Brands
Chad K
CK
Driscoll
David J
DJ
D000293:Adolescent; D000671:Amputation, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007715:Klippel-Trenaunay-Weber Syndrome / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D051346:Mobility Limitation; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000074402:Synovectomy; D054079:Vascular Malformations / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult