Summary: A case report of major tibial bone cist formation after seven years of anterior cruciate ligament reconstruction using bioabsorbable screw for tibial graft fixation, treated with curettage and hibrid bone graft (iliac crest and synthetic bone graft substitute - phosphate calcium)

The anterior cruciate ligament (ACL) reconstruction surgery presented in the past decades some technical variations such as: tunnel positioning, types of graft, types of fixation and types of materials used in implant manufacturing. Currently, absorbable interference screws has been widely used for tibial graft fixation, and can be listed as advantages of this kind of material: the absence of formation of magnetic susceptibility artifacts in the imaging examinations for post-surgical control and greater ease in the management of revision surgeries. On the other hand, there are complications described in the literature, resulting from the biological degradation process of the implant such as synovial cyst formation, screw migration and osteolysis. We reported the case of a 38 years-old man submitted to ACL reconstruction using hamstring autograft, femoral fixation with metallic endobutton and tibial fixation with absorbable interference screw (Poly L-lactic-acid), evolving after 3 years with inflammatory signs around surgical scar and magnetic resonance imaging (MRI) scan showing fragmented interference screw in the tibial tunnel with surrounding bone marrow edema with no other articular disorders. At that time, he was treated with nonsteroidal anti-inflammatory drugs and presented symptoms remission. Seven years after surgery, the same patient returns with pain in proximal tibial region and new MRI scan revealed a massive bone cystic formation in proximal tibial metaphysis (4.6 x 3.7 x 3.1 cm), without apparent continuity with the articular surface and not presenting a clinical symptoms of ligament failure. An arthroscopy of his knee, that didn’t reveal articular injuries, and a curettage associated with cyst biopsy and grafting was performed with autologous iliac crest bone and synthetic bone graft substitute phosphate calcium / calcium sulfate. Histopathology confirmed the presence of macrophages which suggests an inflammatory foreign body reaction. The patient presented a favorable clinical evolution, with good bone graft integration and without clinical symptoms of knee instability or new local inflammatory reactions .

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Tibial Bone Cyst Formation After Anterior Cruciate Ligament Reconstruction Using Absorbable Interference Screw - Case Report

Tibial Bone Cyst Formation After Anterior Cruciate Ligament Reconstruction Using Absorbable Interference Screw - Case Report