Acute Popliteal Artery Thrombosis After Arthroscopic Anterior Cruciate Ligament Reconstruction

An 18-year-old man had a right anterior cruciate ligament (ACL) injury without any vascular complications. He was admitted for arthroscopic ACL reconstruction (ACL-R). After ACL-R, the patient complained of coldness and numbness of the right lower extremity. Emergency computed tomography and angiography showed thrombotic occlusion of the right popliteal artery without any direct injury to the blood vessels (Figure). After aspiration therapy, the blood flow in the popliteal artery improved (Figure). On intravascular ultrasound (IVUS), diffuse intima-media thickness and thrombus at the obstruction site were identified (Figure). The symptoms improved immediately after this procedure. The thrombus disappeared, and intima-media thickness had normalized on duplex ultrasound after 3 months.

Figure.

(A) Computed tomography angiography showing occlusion of the right popliteal artery (white arrowhead). The occlusion was present on the extension line of the tibial screw (yellow arrowheads). (B) Angiography after aspiration therapy. (C–F) Intravascular ultrasound after aspiration therapy: (C) femoral artery; (D,E) popliteal artery with diffuse intima-media thickening (yellow arrows); (F) tibioperoneal trunk.

Vascular complications associated with arthroscopic ACL-R are uncommon.¹ In the present case, popliteal artery occlusion developed immediately after surgery, but there was no direct vascular damage. According to the IVUS findings, it is highly probable that the tip of the drill had reached close to the popliteal artery, causing heat injury that induced the vasospasm.²

Disclosures

The authors declare no conflicts of interest.

References

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