Complex regional pain syndrome complicating an ACL reconstruction : A case report

INTRODUCTION Primary ACL reconstruction has become a widely adopted procedure, successfully restoring knee stability and function and ultimately enhancing patients' quality of life. However, the potential for postoperative complications exists, and in this paper, we present a particularly rare case where ACL reconstruction is complicated by complex regional pain syndrome type I. CASE PRESENTATION We present the case of an 18-year-old male who presented to the emergency department after a fall on his right knee. Initial examination was limited due to knee pain, and the first management involved knee immobilization with a brace and analgesics. After 15 days, a positive LACHMAN test and soft end-feel were identified during a physical examination. A knee MRI confirmed an ACL tear, leading to SEMITENDINOUS/GRACILIS graft reconstruction. Despite postoperative rehabilitation, the patient experienced persistent symptoms after seven months,prompting further evaluation. Blood tests and a new MRI showed no abnormalities, but knee scintigraphy confirmed complex regional pain syndrome type I. A comprehensive rehabilitation program, including physical and psychological support, significantly improved pain management and joint range of motion. CLINICAL DISCUSSION While ACL reconstruction is generally successful, it can give rise to complications. This paper addresses explicitly the infrequent development of complex regional pain syndrome type I (CRPS) in a single patient. The Budapest criteria in 2012 mitigated the diagnostic complexities associated with CRPS and established a global standard for diagnosis. The diagnostic process integrates clinical findings, laboratory tests, X-rays, MRI, and bone scintigraphy. The poorly understood pathogenesis of CRPS is linked to neuroplastic changes, inflammatory processes, and vasomotor functional deficits. A range of treatment options for CRPS exists, including physiotherapy, pharmacological agents, sympathetic blockade, and various procedures. The presented case effectively utilized physiotherapy, NSAIDs, and psychological support, resulting in positive outcomes. CONCLUSION It is essential to consider complex regional pain syndrome as a potential complication in ACL reconstruction, a common and successful procedure. Adequate psychological support, analgesics, and a tailored rehabilitation program can ensure positive outcomes, particularly in cases with limited resources and therapeutic options