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Knee arthroscopic surgery has become one of the most frequently performed orthopaedic procedures. These operations are easily performed and are associated with few risks or complications. Among potential complications, one of the most devastating is the development of acute compartment syndrome.' This phenomenon has been described in the literature. The presumed cause involves fluid extravasation, most likely through a capsular defect, into the dependent soft tissues.We report two patients, who, after arthroscopic procedures of the knee, developed apparent compartment syndromes of the leg. In both cases, the patients were clinically monitored and spontaneous resolutions of the elevated compartment pressures were noted. No sequelae of compartment syndrome developed in either patient. CASE REPORTSCase 1 A 24-year-old man injured his left knee in a mountain bike accident 1 year before surgery. Subjective symptoms of instability were confirmed with a physical examination revealing positive anterior drawer, Lachman's, and lateral pivot shift tests; the findings were consistent with an ACL-deficient knee.The decision was made to proceed with arthroscopic ACL repair. With the patient under a general anesthetic, his left leg was placed in a leg holder. A tourniquet was used about the upper left thigh and inflated to 350 mm Hg. Intraarticular distention was maintained with sterile saline through a pressure-controlled pump. Arthroscopic evaluation revealed an apparent old midsubstance ACL tear, as well as meniscal tears in the posterior horn of both the medial and lateral menisci. Anterior cruciate ligament reconstruction was accomplished using a bone-patellar tendon-bone autograft secured with two cannulated interference screws. Total tourniquet time was 2 hours and 11 minutes.After surgery, the patient's left calf was noted to be tense to palpation. Intraoperative compartment pressures were recorded in all four leg compartments. All pressures were noted to be in excess of 120 mm Hg (Table 1). A diastolic blood pressure of 60 mm Hg was recorded. Clinically, palpable dorsalis pedis and posterior tibialis pulses were noted. The decision was made at that time to awaken the patient to assess for subjective symptoms of compartment syndrome. A neurologic examination revealed no motor or sensory deficits and the patient denied pain with passive stretch of his ankle or great toe.The patient was brought to the recovery room where the left leg was elevated and ice was applied to the knee and calf. Measurements of compartment pressures were repeated and recorded at 1 and 4 hours postoperatively. The pressures fell significantly, to an average of 46 mm Hg by 1 hour and to 23 mm Hg by 4 hours. Serial examinations were also performed in the recovery room postoperatively. No neurologic deficits developed. The left calf became progressively less tense, and by 4 hours postoperatively it was completely soft.The patient was observed overnight. No further signs or symptoms suggestive of compartment syndrome developed. He was discharged home ...

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