부산대학교 도서관

Case Diagnosis: Compartment syndrome following anterior cruciate ligament (ACL) reconstruction causing fibular and tibial neuropathies and lower leg myonecrosis. Case Description: An 18 year-old woman sustained right ACL tear during lacrosse competition. Four weeks later, she underwent reportedly uneventful ACL reconstruction with patellar tendon grafting using femoral and popliteal nerve blocks. Four days later, progressive erythema, pain, and right foot drop were noticed. Anterior and lateral compartment pressures were elevated to 35mmHg, requiring emergent fasciotomies. Compartment pressures normalized, but symptoms persisted and right heel cord contracture developed. Eleven weeks post-op, electrophysiologic testing showed absent fibular and tibial motor and sural sensory responses with extensive fibrillation potentials and "fibrotic resistance" to needle insertion in multiple lower limb muscles. MRI showed diffuse enlargement and hyperintensity of the tibial nerve and myonecrosis of both anterior and posterior compartments. Twelve weeks post-op, neurolysis and decompression of the fibular and tibial nerves was performed in an attempt to improve neuropathic pain. The degree of myonecrosis made prognosis for strength return guarded. Follow-up is pending. Discussions: Compartment syndrome following ACL repair has only been reported once in the literature. Prolonged limb compression, such as intraoperative tourniquet placement, increases risk of developing compartment syndrome. Anesthetic nerve blocks may mask early post-operative pain and dysesthesias. Elevated pressure in the setting of unyielding fascial borders restricts blood supply resulting in ischemia and necrosis of muscles and nerves as observed in this patient. Conclusions: Compartment syndrome is a rare complication following limb surgeries presenting with pain, paresthesias, and/or weakness. Early recognition and intervention is crucial to prevent serious neurologic damage. Risk factors may include prolonged tourniquet time and anesthetic nerve blocks. [ABSTRACT FROM AUTHOR]