Skip to main content
SpringerLink
Log in

Early postoperative transtibial articular fistula formation after anterior cruciate ligament reconstruction: a review of three cases

Archives of Orthopaedic and Trauma Surgery volume 134, pages 829–834 (2014)Cite this article

Abstract

Introduction

This is a retrospective case report of three cases with an early postoperative transtibial fistula after anterior cruciate ligament reconstruction (ACL).

Materials and methods

The patients had undergone ACL reconstruction and complained of fluid drainage through the not-healed wound or swelling localized on the anteromedial aspect of the ipsilateral proximal tibia during the early postoperative. Magnetic resonance imaging showed a multilocular fluid-filled cyst arising from the distal hole of the tibial bone tunnel. Open resection of the fistula and the cyst was performed in all cases and communication between the tibial tunnel and the joint space was confirmed. During revision surgery the distal hole of the tibial tunnel was covered with a fascio-periosteal flap.

Results

All wounds healed without complications. There was no recurrence of drainage or cyst formation. At 2 years follow-up the knee function was normal and was not affected by the complication in any of the patients. Early postoperative transtibial fistulae after ACL reconstruction are rare complications that clinically present either as anterior tibial cysts or persistent wound drainage. Surgical treatment is required, and some delay in the rehabilitation routine is required, but the final outcome is not affected.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

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

Fig. 1
Fig. 2
Fig. 3

References

  1. Mather RC 3rd, Koenig L, Kocher MS, Dall TM, Gallo P, Scott DJ, Bach BR Jr, Spindler KP (2013) Societal and economic impact of anterior cruciate ligament tears. J Bone Joint Surg Am 95(19):1751–1759

    Article  PubMed  Google Scholar 

  2. Cohen SB, Sekiya JK (2007) Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med 26(4):597–605

    Article  PubMed  Google Scholar 

  3. Ahlden M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J (2012) The Swedish national anterior cruciate ligament register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med 40(10):2230–2235

    Article  PubMed  Google Scholar 

  4. Kartus J, Magnusson L, Stener S, Brandsson S, Eriksson BI, Karlsson J (1999) Complications following arthroscopic anterior cruciate ligament reconstruction. A 2–5-year follow-up of 604 patients with special emphasis on anterior knee pain. Knee Surg Sports Traumatol Arthrosc 7(1):2–8

    Article  CAS  PubMed  Google Scholar 

  5. Benedetto KP, Fellinger M, Lim TE, Passler JM, Schoen JL, Willems WJ (2000) A new bioabsorbable interference screw: preliminary results of a prospective, multicenter, randomized clinical trial. Arthroscopy 16(1):41–48

    Article  CAS  PubMed  Google Scholar 

  6. Martinek V, Friederich NF (1999) Tibial and pretibial cyst formation after anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation. Arthroscopy 15(3):317–320

    Article  CAS  PubMed  Google Scholar 

  7. Malhan K, Kumar A, Rees D (2002) Tibial cyst formation after anterior cruciate ligament reconstruction using a new bioabsorbable screw. Knee 9(1):73–75

    Article  CAS  PubMed  Google Scholar 

  8. Brettler D, Soudry M (1995) Tibial bone plug resorption with extra-articular cyst: a rare complication of anterior cruciate ligament reconstruction. Arthroscopy 11(4):478–481

    Article  CAS  PubMed  Google Scholar 

  9. Feldmann DD, Fanelli GC (2001) Development of a synovial cyst following anterior cruciate ligament reconstruction. Arthroscopy 17(2):200–202

    Article  CAS  PubMed  Google Scholar 

  10. Brager MA, Traina SM, Parker AW (2002) Pretibial cyst following anterior cruciate ligament reconstruction using hamstring autografts. Orthopedics 25(1):79–82

    PubMed  Google Scholar 

  11. Deie M, Sumen Y, Ochi M, Murakami Y, Fujimoto E, Ikuta Y (2000) Pretibial cyst formation after anterior cruciate ligament reconstruction using auto hamstring grafts: two case reports in a prospective study of 89 cases. Magn Reson Imaging 18(8):973–977

    Article  CAS  PubMed  Google Scholar 

  12. Ghazikhanian V, Beltran J, Nikac V, Feldman M, Bencardino JT (2012) Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis. Skeletal Radiol 41(11):1375–1379

    Article  PubMed  Google Scholar 

  13. Victoroff BN, Paulos L, Beck C, Goodfellow DB (1995) Subcutaneous pretibial cyst formation associated with anterior cruciate ligament allografts: a report of four cases and literature review. Arthroscopy 11(4):486–494

    Article  CAS  PubMed  Google Scholar 

  14. Simonian PT, Wickiewicz TL, O’Brien SJ, Dines JS, Schatz JA, Warren RF (1998) Pretibial cyst formation after anterior cruciate ligament surgery with soft tissue autografts. Arthroscopy 14(2):215–220

    Article  CAS  PubMed  Google Scholar 

  15. Ruiz-Iban MA, Diaz Heredia J, Cebreiro Martinez Val I, Alonso Guemes S, Cuellar Gutierrez R, Sastre Solsona S (2013) Evolution of C-reactive protein values in the first month after anterior cruciate ligament reconstruction: reference values. Knee Surg Sports Traumatol Arthrosc

  16. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  17. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154

    Article  CAS  PubMed  Google Scholar 

  18. Johnston M, Morse A, Arrington J, Pliner M, Gasser S (2011) Resorption and remodeling of hydroxyapatite-poly-l-lactic acid composite anterior cruciate ligament interference screws. Arthroscopy 27(12):1671–1678

    Article  PubMed  Google Scholar 

  19. Ilahi OA, Younas SA, Sahni IK (2003) Pretibial cyst formation after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 19(2):E5

    PubMed  Google Scholar 

  20. Sekiya JK, Elkousy HA, Fu FH (2004) Recurrent pretibial ganglion cyst formation over 5 years after anterior cruciate ligament reconstruction. Arthroscopy 20(3):317–321

    Article  PubMed  Google Scholar 

  21. Tsuda E, Ishibashi Y, Tazawa K, Sato H, Kusumi T, Toh S (2006) Pretibial cyst formation after anterior cruciate ligament reconstruction with a hamstring tendon autograft. Arthroscopy 22(6):691–696

    Article  PubMed  Google Scholar 

  22. Ramsingh V, Prasad N, Lewis M (2014) Pre-tibial reaction to biointerference screw in anterior cruciate ligament reconstruction. Knee 21(1):91–94

    Article  CAS  PubMed  Google Scholar 

  23. Apostolopoulos A, Nikolopoulos D, Polyzois I, Liarokapis S, Rossas C, Michos I (2012) Pretibial cyst formation after anterior cruciate ligament reconstruction with poly-L acid screw fixation: a case report presentation and review of the literature. J Surg Orthop Adv 21(3):151–156

    Article  PubMed  Google Scholar 

  24. Roberts TS, Drez D Jr, McCarthy W, Paine R (1991) Anterior cruciate ligament reconstruction using freeze-dried, ethylene oxide-sterilized, bone-patellar tendon-bone allografts. Two year results in thirty-six patients. Am J Sports Med 19(1):35–41

    Article  CAS  PubMed  Google Scholar 

  25. Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN (2011) Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction? Clin Orthop Relat Res 469(4):1082–1088

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain

    J. Díaz Heredia, M. A. Ruiz Iban, R. Ruiz Diaz & I. Cebreiro Martinez del Val

  2. Department of Orthopaedic Surgery, Hospital Universitario Donostia, San Sebastián, Spain

    R. Cuéllar Gutiérrez

  3. Department of Dermatology, Hospital Universitario Ramón y Cajal, Madrid, Spain

    L. Turrion Merino

Authors
  1. J. Díaz Heredia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. A. Ruiz Iban
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Cuéllar Gutiérrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Ruiz Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Cebreiro Martinez del Val
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Turrion Merino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Díaz Heredia.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Díaz Heredia, J., Ruiz Iban, M.A., Cuéllar Gutiérrez, R. et al. Early postoperative transtibial articular fistula formation after anterior cruciate ligament reconstruction: a review of three cases. Arch Orthop Trauma Surg 134, 829–834 (2014). https://doi.org/10.1007/s00402-014-1988-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-1988-6

Keywords

search

Navigation