# Post-surgical inflammatory neuropathy after anterior cruciate ligament repair: a case report

## TL;DR

A patient developed post-surgical inflammatory neuropathy after an ACL repair, highlighting a rare but important cause of nerve damage following surgery.

## Contribution

This case report highlights post-surgical inflammatory neuropathy as a potentially under-recognized cause of perioperative neuropathy.

## Key findings

- The patient developed sciatic nerve-related neuropathy after anterior cruciate ligament surgery.
- The diagnosis of post-surgical inflammatory neuropathy was made after ruling out other causes.
- The patient improved with conservative management, suggesting potential for corticosteroid therapy in similar cases.

## Abstract

Unanticipated symptoms of peripheral nerve damage following surgery are distressing to both the patient and their clinical team, including surgeons, anesthesiologists, and neurologists. The causes that are commonly considered for perioperative neuropathy can include surgical trauma, positioning-related injury, or injury related to a regional anesthetic technique. However, these cases often do not have a clear etiology and can occur without any apparent periprocedural anomalies. Postoperative inflammatory neuropathy is a more recently described, and potentially underrecognized cause of perioperative neuropathy which may improve with corticosteroid therapy. Therefore, it is an important etiology to consider early in the evaluation of perioperative neuropathy.

An otherwise healthy patient presented for left anterior cruciate ligament reconstruction. He underwent femoral and sciatic ultrasound-guided single-injection peripheral nerve blocks preoperatively, followed by a general anesthetic for the surgical procedure. He developed postoperative neuropathy in the sciatic distribution with both sensory and motor deficits. The patient received multi-disciplinary consultations, including neurology and pain management, and a broad differential diagnosis was considered. Based on neurological evaluation and imaging studies, a final diagnosis of post-surgical inflammatory neuropathy was made. The patient’s course improved with conservative management, but immunosuppressive treatment may have been considered for a more severe or worsening clinical course.

There are limited publications describing postoperative inflammatory neuropathy, and this case serves to illustrate a potentially under-recognized and multifactorial cause of postoperative neuropathy. Perioperative neuropathies are a complication that surgeons and anesthesiologists strive to avoid; however, prevention and treatment of this condition have been elusive. Increased reporting and investigation of postoperative inflammatory neuropathy as one cause for this complication will help to further our understanding of this potentially devastating complication.