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

Shen, Michael Xuanrong; Sathappan, S S

doi:10.11622/smedj.2013195

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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Purpose The purpose of this study was to perform a scoping review of published literature reporting on surgical management of tibial cysts which developed after ACLR. Methods A scoping review was conducted following the Arksey and O’Malley framework for scoping studies and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. A search strategy using the terms [“Tibial Cyst” AND “ACL”], [“Pretibial Cyst” AND “ACL”] was applied to the PUBMED database. Results Thirty-seven studies published between 1990 and 2019 were a part of this scoping review. Non-absorbable implants for tibial graft fixation were used in 10 studies (comprising a total 21 patients), while bio-absorbable implants were used in 27 studies (comprising a total 115 patients). Incidence of tibial cyst was reported in 3 studies (434 primary ACLRs) from whom 3.9% (n = 17) developed tibial cyst. Tibial cyst development in relation to use of bio-absorbable screws for tibial ACL graft fixation was reported in 16 studies (42.1%). Use of bio-absorbable screws with another factor was found to be related to tibial cyst development in another 1 study (2.6%). Most common symptoms were presence of mass or swelling, pain, tenderness, drainage, instability and effusion. Conclusion This scoping review demonstrated that tibial cysts is more frequently related to bioabsorbable screws, however it can also occur due to other causes. Current literature on tibial cyst after ACLR is of low-quality evidence. Future research is required to better understand aetiology, risk factors for cyst formation and the best possible mode of management. Level of evidence IV

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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…While relatively uncommon, a variety of complications have been noted in case reports after implantation of bioabsorbable screws. Reported complications include bone cysts, 5,9,17,24 pseudocysts, 23 infection, 15,20 extrusion, 1 abscess, 6 and pretibial pain and swelling. 15,22 There have also been 2 case reports of broken screws with associated pathology, either ulceration or chondral lesions.…”

Section: Discussionmentioning

confidence: 99%

“…We also recorded any cyst formation, as this has been noted to be a complication of bioabsorbable screws in previous studies. 5,9,17,23,24…”

Section: Methodsmentioning

confidence: 99%

“…We also recorded any cyst formation, as this has been noted to be a complication of bioabsorbable screws in previous studies. 5,9,17,23,24 Clinical Assessment Physical examination information including assessment of knee stability and range of motion was obtained from medical records. Knee stability as it pertained to the ACL reconstruction was graded using a Lachman test.…”

Section: Data Collectionmentioning

confidence: 99%

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Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft

Scrivens

Kluczynski

Fineberg

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Bioabsorbable interference screws tend to have high resorption rates after anterior cruciate ligament (ACL) reconstruction; however, no studies have examined screws composed of 30% biphasic calcium phosphate and 70% poly-d-lactide (30% BCP/70% PLDLA). Purpose: To evaluate femoral and tibial tunnel widening and resorption of 30% BCP/70% PLDLA interference screws and replacement with bone at 2 to 5 years after ACL reconstruction using bone–patellar tendon–bone (BTB) autograft. Study Design: Case series; Level of evidence, 4. Methods: Included were 20 patients who had undergone ACL reconstruction using BTB autograft and were reevaluated 2 to 5 years after surgery using computed tomography scans. Tunnel measurements were obtained from computed tomography scans in the sagittal and coronal planes and were compared with known tunnel measurements based on operative reports. These images and measurements were used to assess tunnel widening, resorption of the 30% BCP/70% PLDLA screw, its replacement with bone, and possible cyst formation. Paired t tests were used to compare initial and final femoral and tibial tunnel measurements. Results: The cross-sectional area of the femoral tunnel decreased at the aperture ( P = .03), middle ( P = .0002), and exit ( P < .0001) of the tunnel compared with the initial femoral tunnel size, and the tibial tunnel cross-sectional area decreased at the aperture ( P < .0001) and exit ( P = .01) of the tunnel compared with the initial tibial tunnel size. Bone formation was observed in 100% of femoral tunnels and 94.7% of tibial tunnels. Screw resorption was 100% in the femur and 94.7% in the tibia at the final follow-up. Cysts were noted around the femoral tunnel in 2 patients (5.1%). Conclusion: The 30% BCP/70% PLDLA interference screws used for ACL reconstruction using BTB autograft had high rates of resorption and replacement with bone, and there were no increases in tunnel size at 2 to 5 years postoperatively. The authors observed a low rate of cyst formation and no other adverse events stemming from the use of this specific biointerference screw, suggesting that this type of screw is a reasonable option for graft fixation with minimal unfavorable events and a reliable resorption profile.

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“…3,4 Further, cases of painful pretibial cysts have been reported. 5 Such cysts typically are diagnosed by MRI scans, and the cyst and screw remnants are traditionally removed by open extirpation. 3 We report on the use of ultrasound (US) examination for diagnosing painful late tibial cyst formation, the precise perioperative localization of screw remnants by US, and the endoscopic removal of the screw remnants along with the surrounding cyst (by ordinary arthroscopic equipment).…”

mentioning

confidence: 99%

Ultrasound-Assisted Endoscopic Removal of Pretibial Cysts Related to Biointerference Screw Degradation

Solheim¹,

Inderhaug

2021

Arthroscopy Techniques

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We report on the treatment of cases of painful subcutaneous pretibial cyst due to broken and displaced materials of only partly absorbed bioabsorbable interference screws used for anterior cruciate ligament reconstruction. Ultrasound examination was used to both make the definite diagnosis and determine the exact localization of dislodged screw parts. The broken and loose bioabsorbable screw parts and surrounding cyst-like structure were removed endoscopically by a soft-tissue resector.

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

Cited by 6 publications

References 16 publications

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

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

Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone–Patellar Tendon–Bone Graft

Ultrasound-Assisted Endoscopic Removal of Pretibial Cysts Related to Biointerference Screw Degradation

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