Pulmonary embolism manifested as acute coronary syndrome after arthroscopic anterior cruciate ligament reconstruction

Pulmonary embolism (PE) is a rare but serious complication following orthopedic surgery. Routine prophylaxis remains a controversial issue. The current study outlines the case of a 34-year-old male patient with delayed diagnosis of PE 15 days after arthroscopic reconstruction of anterior cruciate ligament (ACL) without thromboprophylaxis. He was diagnosed with acute coronary syndrome initially, but the symptoms could not be relieved after cardiac catheterization. However, PE was finally confirmed 3 days later, after serial examinations. An anticoagulant agent with enoxaparin was administered, which resulted in the relief of symptoms, and he was discharged after 18 days of hospitalization. The symptoms of PE can be similar to those of acute coronary syndrome. Thus, establishing an accurate diagnosis is difficult due to the very low incidence of PE after ACL reconstruction. Some of the possible causes of PE in this patient were his history of smoking, obesity, and surgery with prolonged surgical and tourniquet times. Surgeons should be aware of and pay greater attention to this rare complication after arthroscopic ACL reconstruction, even for young and relatively healthy patients.