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Chronic Tibial Tunnel Infection Following ACL Reconstruction: A Case Report and Review of the Literature

Vol 7 | Issue 1 | January-June 2021 | page: 19-21 | Bishnu Pokharel, Rosan Prasad Shah Kalawar, Ashish Kumar Goyal


Author: Bishnu Pokharel [1], Rosan Prasad Shah Kalawar [1], Ashish Kumar Goyal

[1] Department of Orthopaedics, BPKIHS, Dharan, Nepal. [2] Department of Orthopaedics and Joint Replacement Surgery, Indrparastha Apollo Hospitals, Sarita Vihar, New Delhi, India.
Address of Correspondence
Dr. Ashish Kumar Goyal
Senior Registrar; Department of Orthopaedics and Joint Replacement Surgery Indrparastha Apollo Hospitals, Sarita Vihar, New Delhi, India.
Email: drgoyal41@gmail.com


Abstract

Introduction: Rupture of the anterior cruciate ligament (ACL) is a common injury in active people and one of the most common knee injuries in sports. Foreign body granuloma with concomitant infection is a rare complication in ACL surgery. Very few cases have been reported on it. We present a young patient with a chronic discharging sinus at a surgical site on the tibia in a diabetic patient and its successful management.  

 

 

Case Report: A thirty-two-year-old male presented to us with a persistent discharging sinus at the surgical site following an Anterior Cruciate Ligament (ACL) reconstruction two years back. Since then, he developed wound infection at the incision site created for graft harvesting, which kept on discharging sero-purulent discharge even with several antibiotics and local dressing courses. There was no stiffness or instability in the knee. We did a follow-up arthroscopic evaluation of the joint and debridement of the wound. A portion of hamstring graft and non-absorbable suture with unhealthy granulation tissues were found subcutaneously during the surgery. A partially resorbed bioscrew with unhealthy granulation tissue was observed in the tibial tunnel. After thorough debridement of the site, the wound completely healed.
Conclusion: Surgical site infection and foreign body granuloma should be considered and treated accordingly if the patient presents with persistent discharging sinus at the surgical site in ACL reconstruction
Keywords: Anterior cruciate ligament reconstruction, ACL, Surgical site infection, Tibial tunnel.


References

1) Miyasaka KC, Daniel D, Stone M, and Hirshman P. The incidence of knee ligament injuries in the general population. Am J Knee Surg. 1991; 4: 3-8.
2) Weiss KS, Weatherall JM, Eick J, and Ross JR. (2017). Delayed Tibial Osteomyelitis after Anterior Cruciate Ligament Reconstruction with Hamstrings Autograft and Bioabsorbable Interference Screw: A Case Report and Review of the Literature. Case Reports in Orthopedics. 2017; 1-7. doi:10.1155/2017/6383526.
3) Barber FA. Complications of Biodegradable Materials. Sports Medicine and Arthroscopy Review. 2015; 23(3):149-155. doi:10.1097/jsa.0000000000000076.
4) Barber FA. Complications of biodegradable materials: anchors and interference screws. Sports Medicine and Arthroscopy Review. 2015;3(3):149–155.
5) Frank M, Schmucker U, David S, et al. Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthr. 2008;16: 71–74. https://doi.org/10.1007/s00167-007-0424-7.
6) McAllister DR, Parker RD, Cooper AE, Recht MP, and Abate J. Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med. 1999;27 : 562- 570.
7) Van Tongel A, Stuyck J, Bellemans J, and Vandenneucker H. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med. 2007; 35 : 1059 – 1063.
8) Numazaki H, Kobayashi H, Yoshida K, Hakozaki M, and Konno SI. Prolonged infection at the tibial bone tunnel after anterior cruciate ligament reconstruction. Fukushima J Med Sci. 2017; 63(2):121-125. doi:10.5387/fms.2017-02. 9) O’Neill BJ, Molloy AP, and McCarthy T. Osteomyelitis of the tibia following anterior cruciate ligament reconstruction. International Journal of Surgery Case Reports. 2013;4(2): 143-145. doi: https://doi.org/10.1016/j.ijscr.2012.10.020.
10) Chua CG and Zubair M. A Modified Technique To Treat Infected Tibial Tunnel Post ACL Reconstruction: A Case Report. Malaysian Orthopedic Journal. 2019;13supplA.


How to Cite this article: Pokharel B, Kalawar RPS, Goyal AK | Chronic Tibial Tunnel Infection Following ACL Reconstruction: A Case Report and Review of The Literature | Trauma International | January-June 2021; 7(1): 19-21.

 


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