title: Thrombotic popliteal block following simultaneous bi-cruciate single-stage arthroscopic reconstruction in a neglected multiligamentous knee injury in a smoker.
abstract: We report a case of neglected multiligamentous injury that developed a complete thrombotic popliteal artery block following arthroscopic surgery. A 56-year-old man, a farmer, presented with an 8-month history of instability of the right knee. Examination revealed ipsilateral anterior (ACL)/posterior cruciate ligament (PCL) injuries. MRI and diagnostic arthroscopy confirmed complete ACL/PCL tear. Single-stage arthroscopic ACL/PCL reconstruction was performed. Postsurgery, the operated limb appeared swollen, firm and cold, without sensation or toe movement. Angiogram revealed complete thrombotic block of left popliteal artery. Fogarty's catheterism was performed and distal vascularity re-established. At 28 months, the patient was back at work with good functional outcome. We failed to examine the patient preoperatively in spite of his advanced age, history of beedi smoking and tobacco use, and presence of feeble vascular pulsations with thickened skin over leg and foot. Thus, in multiligamentous injuries, patient selection and thorough detailed clinical examination are the keys to successful arthroscopic procedures.
authors.affiliation: Department of Orthopaedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India.
authors.forename: Ranajit
authors.initials: R
authors.lastname: Panigrahi
authors.affiliation: Department of Physiology, Hi-Tech Medical College, Bhubaneswar, Odisha, India.
authors.forename: Amita Kumari
authors.initials: AK
authors.lastname: Mahapatra
authors.affiliation: Department of Orthopedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India.
authors.forename: Nishit
authors.initials: N
authors.lastname: Palo
authors.affiliation: Department of Orthopedics, Hi-Tech Medical College, Bhubaneswar, Odisha, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Priyadarshi
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000009:adverse effects; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery; D007717:Knee / Q000601:surgery; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000473:pathology*; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D012907:Smoking / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology*