Delayed Pseudoaneurysm of the Popliteal Artery Following ACL Reconstruction

Arterial complications following arthroscopic anterior cruciate ligament (ACL) reconstruction of the knee are rare. Injuries to vascular structures around the knee have historically been reported more commonly, with reconstructive procedures occurring more posteriorly, such as posterior cruciate ligament (PCL) reconstruction. The authors present a report of sequelae following a postoperative popliteal artery spasm in an 18-year-old female soccer player who underwent ACL reconstruction using an ipsilateral autologous hamstring graft along with a medial meniscal repair and developed immediate spasm of the popliteal artery responding to sustained balloon angioplasty. Seven weeks postoperatively, she developed foot paresthesias and was noted to have a 3.5×3.1×1.3-cm pseudoaneurysm of her popliteal artery. She underwent popliteal artery bypass with reverse saphenous vein autograft and had an uneventful recovery. This case highlights the importance of prolonged follow-up and maintaining a high degree of suspicion for further arterial complications, even after routine arthroscopic knee procedures. In addition to maintaining close and extended follow-up, the authors agree with other authors' suggestions that urgent computed tomography angiogram be obtained to evaluate the vascular tree in a patient presenting with a cold, pulseless extremity after routine arthroscopic knee procedures. In this particular case, angiography of the uninvolved side also proved useful in identifying the patient's aberrant vascular anatomy and may be useful in patients with bilateral aberrant vascular anatomy to better facilitate interpretation of the injured side. To the author's knowledge, this is the first case of popliteal artery spasm initially responding to sustained angioplasty with the delayed development of a pseudoaneurysm.