1.    Singapore Med J. 2013 Oct;54(10):e211-4. Painful pretibial pseudocyst at bioabsorbable interference screw aperture two years after anterior cruciate ligament reconstruction. Shen MX(1), Sathappan SS. Author information: (1)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433. sheny_mike@hotmail.com. 

We report the case of a patient with a painful subcutaneous nodule, measuring 13 mm × 17 mm, at the pretibial graft aperture site, which presented two years after a successful anterior cruciate ligament reconstruction with an autologous hamstring graft. A bioabsorbable poly-L-lactide interference screw was used for graft fixation at the tibial aperture. The patient underwent surgical excision of the lesion and curettage at the tunnel aperture. Grossly, extruded fragments of the screw and a thick pseudocapsule of surrounding tissue were excised. There was no communication between the tunnel aperture and the knee joint. The graft was also intact. Histological analysis revealed fragments of the bioabsorbable material in association with fibrous and granulomatous chronic inflammatory cells. This was consistent with a foreign body reaction. The patient subsequently recovered and resumed preinjury level of activity. To the best of our knowledge, this is the first report describing a nodular granulomatous type reaction to foreign bioabsorbable poly-L-lactide screw material subsequent to an anterior cruciate reconstruction surgery. PMID: 24154591 [PubMed - indexed for MEDLINE]

2.    Arthroscopy. 2008 Jan;24(1):88-95. doi: 10.1016/j.arthro.2007.08.012. Epub 2007 Nov 5. Additional surgery after anterior cruciate ligament reconstruction: can we improve technical aspects of the initial procedure? van Dijck RA(1), Saris DB, Willems JW, Fievez AW. Author information: (1)Department of Orthopedic Surgery and Traumatology, OLVG Amsterdam, UMCU Utrecht, Amphia Hospital Breda, The Netherlands. robvang@hotmail.com 

PURPOSE: To determine factors that cause reoperation after anterior cruciate ligament (ACL) reconstruction and determine which cause of reoperation can be addressed to help to improve technical aspects of the initial procedure. METHODS: Between 1988 and 1998, 436 patients underwent an ACL reconstruction by a single surgeon. We analyzed all 207 patients who had a bone-patellar tendon-bone reconstruction (BPTB). The same technique was used in all operations, which consisted of the 1-incision endoscopic approach with autologous central third patellar-tendon graft. Of these patients, 196 were available for full evaluation. Evaluation included: a detailed history, physical examination, functional knee ligament testing, KT-1000 arthrometer testing, One-leg-hop testing, Lysholm score, Tegner score, and the International Knee Documentation Committee standard evaluation form. All technical surgical aspects concerning the index operation and the reoperations were collected and evaluated in detail to detect predictors for failure or improvement. Position of the graft was measured radiographically using the Amis circle and Taylor score. RESULTS: The average age of the 196 patients at the time of the operation was 34 years, and the mean duration of follow-up was 7.4 years. Seventy-seven reoperations were performed in 54 (27.6%) patients during a period of 83 months post surgery. Reoperations were done between day 22 and 83 months post-ACL reconstruction. Indications for reoperations were: pain caused by fixation material (n = 25); meniscal lesions (n = 24); cyclops lesion (n = 16); donor site morbidity (n = 5); re-rupture of the ACL (n = 5); posterior cruciate ligament rupture (n = 1); and a medial collateral ligament lesion (n = 1). A more ventral position of the graft on the femur (Amis <60%) was correlated with a higher frequency of meniscal lesions and cyclops lesions (P < .01). Patients who had a meniscal lesion after an ACL reconstruction had significantly lower Lysholm (P < .05) and Tegner scores (P < .01). CONCLUSIONS: A large percentage of the patients (27.6%) required additional surgical procedures after patellar tendon autograft ACL reconstruction. A poor position of the graft resulted in cyclops and meniscal lesions. Analyzing the reasons for reoperations gives information about how to improve our surgical technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series. PMID: 18182208 [PubMed - indexed for MEDLINE]


AuthorRosie Browne