Skip to main content
SpringerLink
Log in

Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

  • Review Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1–5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Bencardino JT, Beltran J, Feldman MI, et al. MR imaging of complications following anterior cruciate ligament graft reconstruction. Radiographics. 2009;29(7):2115–26.

    Article  PubMed  Google Scholar 

  2. Meyers AB, Haims AH, Menn K, et al. Imaging of anterior cruciate ligament repair and its complications. Am J Roentgenol. 2010;194:476–84.

    Article  Google Scholar 

  3. Bedi A, Maak T, Musahi V, et al. Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction. Is the tibial tunnel most important? Am J Sports Med. 2011;39(2):366–73.

    Article  PubMed  Google Scholar 

  4. Matsumoto A, Howell SM. Avoiding posterior cruciate ligament and roof impingement with transtibial anterior cruciate ligament reconstruction: keys to correct tunnel placement. Tech Orthop. 2005;20(3):211–7.

    Article  Google Scholar 

  5. Flik K, Bach B. Anterior cruciate ligament reconstruction using an endoscopic technique with patellar tendon autograft. Tech Orthop. 2005;20(4):361–71.

    Article  Google Scholar 

  6. Magnussen RA, Lawrence JT, West RL. Graft size and patient age are predictors of early revision after ACL reconstruction with hamstring tendon autograft. Arthroscopy. 2012;28(4):526–31.

    Article  PubMed  Google Scholar 

  7. Iorio R, Vadala A, Argento G, et al. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop. 2007;31:49–55.

    Article  PubMed  Google Scholar 

  8. Simonian PT, Wickiewicz TL, O’Brien SJ, et al. Pretibial cyst formation after anterior cruciate ligament surgery with soft tissue autografts. Arthroscopy. 1998;14:215–20.

    Article  PubMed  CAS  Google Scholar 

  9. Deie M, Sumen Y, Ochi M, et al. Pretibial cyst formation after anterior cruciate ligament reconstruction using auto hamstring grafts: two case reports in a prospective study of 89 cases. Magn Reson Imag. 2000;18:973–7.

    Article  CAS  Google Scholar 

  10. Tsuda E, Ishibashi Y, Tazawa K, et al. Pretibial cyst formation after anterior cruciate ligament reconstruction with a hamstring tendon autograft. Arthroscopy. 2006;22(6):691.e1–e6.

    Article  Google Scholar 

  11. Lamprakis AA, Fortis AP, Dimas A. Rejection reaction to stabilizing bolts after ACL reconstruction: a case report. Knee Surg, Sports Traumatol, Arthrosc. 2008;16:19–23.

    Article  Google Scholar 

  12. Martinek V, Friederich NF. Tibial and pretibial cyst formation after anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation. Arthroscopy. 1999;15:317–20.

    Article  PubMed  CAS  Google Scholar 

  13. Victoroff BN, Paulos L, Beck C, et al. Subcutaneous pretibial cyst formation associated with anterior cruciate ligament allografts: A report of four cases and literature review. Arthroscopy. 1995;11:486–94.

    Article  PubMed  CAS  Google Scholar 

  14. Gonzalez-Lomas G, Cassilly RT, Remotti F, et al. Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction? Clin Orthop Relat Res. 2011;469:1082–8.

    Article  PubMed  Google Scholar 

  15. Sekiya JK, Elkousy HA, Fu FH. Recurrent pretibial ganglion cyst formation over 5 years after anterior cruciate ligament reconstruction. Arthroscopy. 2004;20:317–21.

    Article  PubMed  Google Scholar 

  16. Ahn JH, Lee YS, Chang MJ. Post-tibial cyst formation over 2 years after posterior cruciate ligament reconstruction. Knee Surg, Sports Traumatol, Arthrosc. 2008;16:996–8.

    Article  Google Scholar 

  17. Sanders TG, Tall MA, Mulloy JP, et al. Fluid collections in the osseous tunnel during the first year after anterior cruciate ligament repair using an autologous hamstring graft: natural history and clinical correlation. J Comput Assist Tomogr. 2002;26(4):617–21.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Varand Ghazikhanian

  2. Maimonides Medical Center, Brooklyn, NY, 11219, USA

    Javier Beltran

  3. Department of Radiology, Maimonides Medical Center, Brooklyn, NY, 11219, USA

    Violeta Nikac

  4. 703 Riverway Place, Bedford, NH, 03110, USA

    Marina Feldman

  5. NYU Hospital for Joint Diseases, New York, NY, 10003, USA

    Jenny T. Bencardino

Authors
  1. Varand Ghazikhanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Javier Beltran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Violeta Nikac
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marina Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jenny T. Bencardino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Varand Ghazikhanian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghazikhanian, V., Beltran, J., Nikac, V. et al. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol 41, 1375–1379 (2012). https://doi.org/10.1007/s00256-012-1486-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1486-2

Keywords

Search

Navigation