Horia Haragus, Voichita Lazureanu, Radu Prejbeanu, Mihail - Lazar Mioc, Anca Boscu, Daniela Radu<br>Painful Pretibial Cyst with Bioabsorbable Poly-L-lactic Acid Screw Migration 4 Years after Anterior Cruciate Ligament Reconstruction

Horia Haragus, Voichita Lazureanu, Radu Prejbeanu, Mihail - Lazar Mioc, Anca Boscu, Daniela Radu
Painful Pretibial Cyst with Bioabsorbable Poly-L-lactic Acid Screw Migration 4 Years after Anterior Cruciate Ligament Reconstruction

Abstract:

Several reported complications have been specifically linked to bioabsorbable interference screws. Due to the rarity of their occurrence, we aim to report a case of simultaneous pretibial cyst formation and intact screw extrusion, 4 years after successful anterior cruciate ligament (ACL) reconstruction using hamstrings autograft. The neoligament was fixed using button and loop on the femoral side and a poly-L-lactic acid (PLLA) interference screw on the tibia. Three and a half years after index reconstruction the patient complained of pain in the area of the extraarticular tibial aperture. Magnetic resonance imaging (MRI) revealed bone edema surrounding the tunnel. The patient went on to develop a progressively aggravating painful lesion. Repeated MRI showed screw extrusion and subcutaneous pretibial cyst formation. A slight tunnel enlargement was also noticed. Surgical debridement revealed cystic membrane with aseptic fluid content. The PLLA screw showed no signs of degradation and was removed intact. There was no apparent joint communication and therefore no bone grafting was deemed necessary. The patient had a favorable outcome with no reoccurrence at 3 months. Although very rare, adverse event from PLLA implants requiring removal may question their most valuable characteristic - biodegradability. Keywords: pretibial cyst, PLLA, screw extrusion, ACL reconstruction

Issue: 2015, Volume 66, Issue 10

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