Pre-tibial reaction to biointerference screw in anterior cruciate ligament reconstruction

We aim to report a series of cases that presented as pre-tibial swelling and pain following anterior cruciate ligament (ACL) reconstruction using bioabsorbable fixation devices.

All ACL reconstructions done between 2007 and 2010 were reviewed retrospectively to identify complications related to bioabsorbable fixation devices. We performed 273 ACL reconstructions over a period of three years from 2007 to 2010 using a bioabsorbable screw for tibial fixation of the quadrupled hamstring autograft.

Fourteen patients (5%) at mean age of 30 (range 16-47) years, presented to us at a mean post-operative period of 26 months (range 12-39) with pre-tibial pain and swelling over the tibial screw site. All of them had normal inflammatory markers. All of these patients underwent surgical debridement, which revealed remnants of screw and reactive material. There was no evidence of infection in the intra-operative specimen cultures. Histopathology revealed a reactive appearance and surrounding myxoid changes. Removal of screw debris and curettage of the tunnel resulted in complete recovery of all patients at a mean follow up of 12 (range 8-16) months.

Pre-tibial cyst along with other adverse biological response should be considered as a possible complication in ACL reconstruction. We report an incidence of 5% of pre-tibial reaction in patients undergoing ACL reconstruction with bio-absorbable interference screw fixation for the proximal tibia.