Clin Orthop Surg.  2016 Mar;8(1):110-114. 10.4055/cios.2016.8.1.110.

Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

• Kim SB
• Lim JW
• Seo JG
• Ha JK

• KMID: 2363954
• DOI: http://doi.org/10.4055/cios.2016.8.1.110

Abstract

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.

Keyword

Anterior cruciate ligament; Anterior cruciate ligament reconstruction; Compartment syndromes; Arterial embolism; Arterial injury

MeSH Terms

Adult
Anterior Cruciate Ligament Reconstruction/*adverse effects
*Compartment Syndromes
Fasciotomy
Humans
*Iatrogenic Disease
Male
Necrosis
*Postoperative Complications
Republic of Korea
Tibia/*surgery
Tibial Arteries/*injuries

Figure

• 

  Fig. 1 (A) Postopertaive anteroposterior X-ray. (B) Postoperative lateral X-ray. These postoperative X-rays demonstrate that the direction of the screw is relatively posterior and that the length is long.

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  Fig. 2 Postoperative computed tomography (CT) and angiogram images. (A) The axial CT images show total occlusion of the left popliteal artery (arrow) and nonvisualization of the left anterior tibial artery (arrow head) with a trace of drilling in the fibula (open arrow). (B) The screw tip (open arrow) is placed 1 cm distal to the popliteal occlusion site (arrow) and 5 mm proximal to the root of the anterior tibial artery (arrow head). (C) On the axial CT image, the screw tip (open arrow) is 15 mm away from the anterior tibial artery (arrow).

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  Fig. 3 The computed tomography angiogram shows filling defects along the entire course of the anterior tibial artery (arrow), a section of the popliteal artery (arrow head), and collateral vessels around the bicortical screw fixation site (open arrow).

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