Treatment of recurrent infection at the tibial bone tunnel after anterior cruciate ligament reconstruction using a medial gastrocnemius muscle flap – A case report

Arthroscopic debridement and antibiotic-loaded cement for treatment of chronic infected tibial tunnel post-ACL reconstruction: A case report

“…Inflammatory markers in the blood, such as erythrocyte sedimentation rate and CRP, are often elevated [ [7] , [8] , [9] ]. MRI of the knee joint shows a lot of joint fluid, thickening of the synovial membrane, and an image of the inflammatory fluid circulation between the joint and the tibial tunnel [ 4 ]. This condition is treated with arthroscopic debridement, continuous irrigation of the joint, and preservation or removal of grafts and implants if the graft is no longer functional [ 2 , 3 , 10 ].…”

“…Some previous reports suggested that the treatment method would be to remove the implant, curettage the inflammatory bone, and cement the tibial tunnel; however, the recurrence rate was still high. Gioi and colleagues performed the abovementioned method but failed and had to use the medial gastrocnemius muscle flap to cover it; the author supposed the leading cause of failure was the remnant of inflammatory bone and non-absorbable suture in the tunnel [ 4 ]. To our knowledge, this is the first case report applying an arthroscopic technique to treat chronic infection of the tibial tunnel after ACL reconstruction surgery.…”

“…In this case, the bacteria found after surgery was Staphylococcus aureus . Some studies show the advantages of antibiotic-loaded cement in treating chronic infection of the tibial tunnel after ACL reconstruction [ 4 , 11 , 12 ]. In addition to filling gaps, antibiotic-loaded cement helps maintain a high concentration of local antibiotics.…”

“…There are some reports in which this disease was treated by removing the implants, curettage of the inflammatory bone, and cementing the tibial bone tunnel. However, recurrence still occurred [ 4 ]. The cause of recurrence may be due to the failure to eradicate the infected bone and non-absorbable suture in the wall of the bone tunnel due to the limited observation of the tibial tunnel with the naked eye ( Fig.…”