Massive Proximal Extravasation as a Complication during Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Extra-articular extravasation of irrigation fluid is relatively common around entry incisions and is usually limited to the subcutaneous tissue. Very rarely, extravasation occurs above the knee, in the thigh and even up into the pelvis. We are reporting the second case of irrigation fluid extravasation during a knee arthroscopy, which spread up to the thigh, groin and perineum during anterior cruciate ligament reconstruction, whilst the tourniquet was inflated. In our case, we think that the extravasation was caused by a fault in the pressure sensor due to the fact that the reservoir was over-filled. The irrigation pressure was therefore too high, and the irrigation fluid was able to diffuse, despite the presence of a pneumatic tourniquet, up past the thigh.

Keywords: Aneterior cruciate ligament; Complications; Knee.

Fig. 1

Clinical appearance of the infiltration of the thigh, pelvis and scrotum due to extravasation of irrigation fluid.

Fig. 2

Ultrasound view of the scrotum showing an effusion (white arrow) around a normal testicle (white star).

Fig. 3

View of the front of the arthroscopy pump and the reservoir (A). The reservoir is half-full (arrow), the pressure values are correct (B). The reservoir is completely filled (arrow), the pressure values are distorted (C).

Fig. 4

Computed tomography (CT) image of the lower end of the femur showing the proximity of the femoral tunnel and the intramedullary cavity (nail position). (A) CT image cross-section. (B) Frontal reconstructed CT image. (C) Sagittal reconstructed CT image.