Foreign body reaction to a bioabsorbable interference screw after anterior cruciate ligament reconstruction

Abstract

Bioabsorbable interference screws have been effective for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of these screws is low but some unique problems have been reported in the literature. We present a case of unusual tissue reaction to a bioabsorbable interference screw following ACL reconstruction.A young male underwent ACL reconstruction, during which a bioabsorbable interference screw was used for graft fixation at the tibial end. The patient presented with a pretibial swelling at 30 months after the operation. Exploration revealed chalky white remnants of the bioabsorbable screw with no evidence of infection. Histological studies confirmed a foreign body reaction against screw remnants with the presence of multinucleated giant cells.The patient had a full recovery with no compromise to graft stability. Bioabsorbable interference screws are usually inert but can initiate a tissue reaction. The presentation can be as late as 2-3 years postoperatively and may mimic an infection. Satisfactory results can be achieved by proper exploration and debridement.

A comprehensive scoping review of tibial cysts after anterior cruciate ligament reconstruction

“…The publication dates of the included studies ranged from 1999 to 2019. Using the adjusted Oxford Center For Evidence‐Based Medicine criteria [74, 75] for the level of evidence we found that 1 study was Level I [11], 1 Level II [25], 1 Level III [57] and 34 studies were level IV [1, 3, 10, 12–17, 19–21, 23, 29, 33, 36, 42, 43, 46, 49, 51, 53, 54, 56, 58, 59, 62, 64–66, 69, 71, 72] case series or case reports.…”

Delayed Tibial Osteomyelitis after Anterior Cruciate Ligament Reconstruction with Hamstrings Autograft and Bioabsorbable Interference Screw: A Case Report and Review of the Literature

“…The signs and symptoms of a late infection present a challenge in the setting of a bioabsorbable interference screw. Biologic reactions to these screws have been shown to include pretibial cysts, granuloma formation, tunnel widening, and inflammatory reactions [ 13 , 14 , 26 , 39 – 41 ]. Several other complications have been documented in the literature, which include screw breakage, fixation failure, screw migration, osteolysis, and joint effusions [ 14 ].…”

“…Umar et al described the onset of pretibial swelling 30 months after ACL reconstruction with PLLA interference screw. Surgical exploration demonstrated chalky debris within the tibial tunnel and histologic evaluation showed an aseptic foreign body reaction with multinucleated giant cells [ 41 ].…”