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  • Delayed onset bioabsorbable screw reaction, intact screw extrusion and Pseudomonas aeruginosa tibial tunnel osteomyelitis years after arthroscopic anterior cruciate ligament reconstruction using hamstring graft

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Unusual association of diseases/symptoms
Case report
Delayed onset bioabsorbable screw reaction, intact screw extrusion and Pseudomonas aeruginosa tibial tunnel osteomyelitis years after arthroscopic anterior cruciate ligament reconstruction using hamstring graft
  1. Patricio III Espinoza Dumlao1,
  2. Nilo Paner1,
  3. Lyndon Bathan1 and
  4. Bryan Albert Lim2
  1. 1 Department of Orthopedics, University of the Philippines Manila, Ermita, Manila, Metro Manila, Philippines
  2. 2 Department of Internal Medicine, Infectious Disease Service, Philippine General Hospital, University of the Philippines, Manila CIty, Philippines
  1. Correspondence to Dr Patricio III Espinoza Dumlao, pedumlao{at}up.edu.ph, patricio3dumlao{at}rocketmail.com

Abstract

Postoperative reaction and infection after anterior cruciate ligament (ACL) reconstruction is a rare complication. We report two cases of bioabsorbable screw extrusion and Pseudomonas aeruginosa tibial tunnel infection in 17/18-year-old men, 2 and 4 years after ACL reconstruction, respectively. They underwent tibial tunnel debridement, removal of the still intact poly-L-D-lactic acid bioabsorbable screw and subsequent wound closure. Physical examination findings confirmed patency of the hamstring graft. Culture guided antibiotics were completed, and wounds healed unremarkably. Both returned to previous level of activity. Successful treatment is achieved through a logical sequence of management, as well as a multidisciplinary approach to prevent unnecessary secondary procedures and morbidity.

  • orthopaedics
  • bone and joint infections
  • unwanted effects/adverse reactions

https://doi.org/10.1136/bcr-2019-229927

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    Footnotes

    • Contributors PIIIED: corresponding author surgeon, main data compiler and main editor, followed-up patients' course. NP: muskuloskeletal infection expert, wound care consultant, editor. LB: consultant surgeon, physical therapy guide. BAL: infectious disease specialist expert, antibiotic steward, editor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.