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Painful pretibial pseudocyst at bioabsorbable interference screw aperture two years after anterior cruciate ligament reconstruction

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Singapore Med J 2013; 54(10): e211-e214; http://dx.doi.org/10.11622/smedj.2013195
Painful pretibial pseudocyst at bioabsorbable interference screw aperture two years after anterior cruciate ligament reconstruction

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Shen MX, Sathappan SS
Correspondence: Dr Michael Shen Xuanrong, sheny_mike@hotmail.com

ABSTRACT
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.

Keywords: bioabsorbable interference screw, granuloma, pseudocyst, polylactic acid
Singapore Med J 2013; 54(10): e211–e214;  http://dx.doi.org/10.11622/smedj.2013195

http://smj.org.sg/sites/default/files/5410/5410cr5.pdf

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