Ultrasound-assisted Endoscopic Evacuation of Recurrent Calf Hematoma Following Anterior Cruciate Ligament Reconstruction. Case Study

Hematoma of the calf is a rare complication following anterior cruciate ligament reconstruction (ACLR). The golden standard method of its treatment is puncture and aspiration. More advanced procedures are needed in difficult cases, such as prolonged he-ma-tomas. Among the novel management choices is endoscopy with ultrasound guidance. The aim of the study was to present the management of a post-surgical hematoma of the calf using endoscopic and ultrasound-assisted surgery. A 48-year-old patient un-der-went arthroscopic ACLR grafted with hamstrings tendons (semitendinosus and gracilis). Due to a hematoma developing at the donor site, he experienced edema and paresthesiae of the calf and foot that enhanced over time. An open reoperation failed and symptoms recurred. A second reoperation was performed as an endoscopic and ultrasound-assisted mini-invasive procedure. Re-sults were assessed postoperatively using the IKDC 2000 and Lysholm questionnaires. An evident increase in IKDC 2000 Score (from 14.9 points after open surgery to 77.0 one week after endoscopic treatment) and Lysholm Scale (26 points after first surgery and 84 one week after endoscopic surgery) was observed after the mini-invasive procedure. Edema and paresthesiae of the affect-ed limb completely disappeared four weeks after endoscopy. No complications of the novel procedure were found. Accordingly, en-doscopic and ultrasound-assisted evacuation of a prolonged calf hematoma appears an effective minimally-invasive and tar-geted procedure.