Tibial interference screw removal following anterior cruciate ligament reconstruction

A small number of patients developed pain and tenderness at the tibial tunnel following anterior cruciate ligament reconstruction. Twenty-three knees in 22 patients underwent removal of the tibial interference screw. Ten knees had a preoperative flexion contracture and underwent a concomitant procedure to address the loss of motion at the time of hardware removal. In the 13 knees with full extension, the interval between ligament reconstruction and screw removal averaged 16 months. Eleven of these knees also underwent arthroscopy, but no intra-articular causes of pain were identified. Roentgenographic analysis showed protrusion of the interference screw above the tibial cortex in three cases. Follow-up after hardware removal averaged 2 years. Tibial tunnel tenderness resolved in 21 of 23 knees, including those of the two patients who underwent hardware removal alone. Although it cannot be stated with certainty that tibial interferences screws may cause pain, this review suggests an association. This is an uncommon problem and it is estimated to be a factor in less than 3% of the author's anterior cruciate ligament reconstructions. More common causes of knee pain should be sought before electing to remove the tibial interference screw.