Acute compartment syndrome in an anterior cruciate ligament revision: a case report

Acute compartment syndrome (ACS) is a rare but serious complication of anterior cruciate ligament (ACL) reconstruction. We present the case of a 21-year-old male soccer player who developed ACS during revision ACL reconstruction. The patient had previously undergone ACL reconstruction and revision was indicated for recurrent instability and graft rupture confirmed by MRI. At the end of the procedure, marked intraoperative edema prompted a medial fasciotomy, which decompressed the superficial and deep posterior compartments. The patient recovered without complications, returned to sport within nine months, and experienced no residual deficits. This case is distinct in that ACS was diagnosed intraoperatively, enabling immediate fasciotomy and preventing postoperative morbidity. Comparison with existing literature highlights that while ACS after ACL reconstruction is uncommon, it remains a critical risk. Lessons include the need for intraoperative vigilance, timely surgical decompression when swelling suggests impending ACS, and the potential for excellent functional outcomes with early intervention.