Popliteal artery compression: a complication of Gore-Tex anterior cruciate ligament reconstruction.

Use of the Gore-Tex polytetrafluoroethylene (PTFE) braided ligament (W. L. Gore & Associates Inc, Flagstaff, Arizona) for reconstruction of the anterior cruciate ligament (ACL) is associated with high rates of recurrent effusion and ligament rupture (Indelicato, Pascale and Huegel 1989; Fu and Olson 1992). In addition, osteolysis in the tibial tunnel has been reported due to a histiocytic response to PTFE particles released by abrasion (Seemann and Steadman 1993). We report a case in which a cyst which formed around the femoral insertion of a ruptured Gore-Tex ligament resulted in intermittent claudication. Case report. In 1985, a 37-year-old male competitive hockey player had reconstruction of an ACL with a GoreTex PTFE prosthesis using the ‘over-the-top’ route. He returned to sport but four years later noticed increasing instability. In June 1993 he suddenly developed a cramping pain in the right calf after walking 100 yards; this settled with rest but returned on further exercise. His peripheral pulses were normal but the ankle-brachial index (ABI) was 0.7. Venography was normal. The calf claudication continued for two weeks before disappearing spontaneously and then reappearing during the next month. Femoral arteriography and Doppler wave forms were normal. A stress test produced severe cramping pain in the calf and a decrease in the ABI from 1.21 to 0.25. At this stage, his pain-free walking distance was 300 metres; he denied any altered sensation or footdrop. He was not diabetic but smoked 20 cigarettes a day. Clinical examination of the knee showed mild varus alignment with medial compartment crepitus, no evidence of function of the Gore-Tex ligament but no effusion. His lumbar spine, peripheral sensation and pulses were normal. Radiographs showed tricompartmental osteoarthritis with posterior osteophytes and CT revealed that a large cystic structure was compressing and displacing the neurovascular bundle (Fig. 1a).