Case Report ArteriovenousFistulaafterAnatomicAll-InsideAnteriorCruciate Ligament Reconstruction MathijsC.H.W.Fuchs, 1 Martijn Dietvorst, 1 RoelVaes, 2 MaartenLoos, 2 MatthijsP.Somford, 3 andRobP.A.Janssen 1 1 Department of Orthopaedic Surgery and Traumatology, Maxima Medisch Centrum, Postbus 7777, 5500 MB Veldhoven, Netherlands 2 Department of Vascular Surgery, Maxima Medisch Centrum, Postbus 7777, 5500 MB Veldhoven, Netherlands 3 Department of Orthopaedic Surgery and Traumatology, Rijnstate Hospital, Postbus 9555, 6800 TA Arnhem, Netherlands Correspondence should be addressed to Mathijs C. H. W. Fuchs; thijnfuchs@gmail.com Received 25 August 2017; Accepted 23 October 2017; Published 26 November 2017 Academic Editor: Eyal Itshayek Copyright©2017MathijsC.H.W.Fuchsetal.isisanopenaccessarticledistributedundertheCreativeCommonsAttribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. We present the first case of an arteriovenous fistula after an all-inside anterior cruciate ligament (ACL) reconstruction. A seventeen-year- oldboyhadanuneventfulACLreconstruction.Fourweeksaftersurgery,thepatientwasseenwithapulsatingswellingatthelateraldistal upper leg. Vascular consultation led to the diagnosis of pseudoaneurysm and arteriovenous fistula of the lateral superior genicular artery. Most likely, fistula is caused by the stab incision for preparation of the femoral tunnel, and no anatomical cause was found. e clinical presentation,previouscasesofarteriovenousfistulaafterarthroscopicACLreconstruction,possiblecauses,andmanagementarediscussed. 1.Introduction eoverallincidenceofACLinjuryis78per100,000persons [1]. e group between 15 and 39 years of age shows an incidence of 85–91 in 100,000 people and could be described as the group at risk [2]. Reconstruction of the ACL ranks number 6 of the most performed orthopaedic operations [3]. Vascular complications after ACL reconstructions are rare but can cause serious morbidity and potential mortality [4]. Vascular complications may occur after various methods of reconstructionandfixation[5].Since2013,wehaveswitched to the all-inside ACL reconstruction technique (Arthrex, M¨ unchen). is technique is a modification of the full tibial tunneltechniqueintheformofatibialsocket,resultinginless pain and less traumatic drilling by using the FlipCutter technique and stab incisions [6]. In this report, we present the first case of an arterio- venous fistula after an all-inside anterior cruciate ligament reconstruction. 2.CaseReport A seventeen-year-old boy presented at the outpatient clinic. Previous medical history reveals the diagnosis of anterior cruciateligamentruptureafteranoncontacttraumaoftheright kneeatagetwelve.Aconservativebracetreatmentwasinitiated, and surgery was postponed till closure of the growth plates. Fourweekspriortotheoutpatientvisit,heunderwentan all-inside ACL reconstruction with hamstring tendon au- tograft with TightRope fixations [6]. e procedure was uneventful, and the patient was discharged the day after surgery. e X-ray showed adequate tunnel and fixation of the graft one day after the surgery (Figures 1(a) and 1(b)). Routine follow-up after two weeks showed a normal post- operative knee: adequate wound healing and slight swelling of the joint with a range of motion 0 ° –110 ° without signs of neurovascular complications. Reasons for the unscheduled outpatient visit at 4 weeks werecomplaintsofanewswelling10dayspreviouslyonthe lateraldistalupperleg.epatientfeltslightpainatthesite of the swelling at the end of the day although he was not limited during daily living or rehabilitation. Physical ex- amination showed a painless, pulsating swelling, sized two by two centimetres. Location was nearby the stab incision made for the femoral fixation of the ACL graft. ere was aslightswellingoftheknee,rangeofmotionwas110 ° to0 ° , and the lower leg was neurovascular intact. Hindawi Case Reports in Orthopedics Volume 2017, Article ID 1034018, 4 pages https://doi.org/10.1155/2017/1034018