Skip to main content
SpringerLink
Log in

Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To describe the clinical results of patients who underwent surgical treatment for a intra-osseous tibial tunnel cyst on a bioabsorbable interference screw following anterior cruciate ligament reconstruction (ACL).

Methods

This retrospective study included all patients who underwent surgery between 2004 and 2016 for an intra-osseous tibial tunnel cyst on bioabsorbable interference screw following ACL reconstruction. The diagnosis was suggested clinically by pretibial pain at the incision site, sometimes associated with a palpable subcutaneous nodule and then confirmed on MRI. The first stage of surgery included exploratory arthroscopy followed by open excision/curettage of the cyst and then the tunnel was filled. The main criterion for outcome was a clinically normal knee (no pain, 0–120 range of motion, stable, with no effusion) at 6 months of follow-up.

Results

This series included 53 patients, mean age 35.3 ± 9.9 years old w ith a mean 4.6 ± 3.1 years (between 3.1 months and 19 years) of follow-up after ligament reconstruction. The tibial screw was completely absorbed in 9/53 (17%) of patients, and fragmented in 22/53 (41.5%). At the 6-month follow-up, 42/53 (79.2%) patients had a normal knee, 11/53 (20.8%) persistent pain in the cyst area, 52/53 (98.1%) normal range of motion and 53 (100%) a stable knee. A recurrent cyst developed at 2 years of follow-up in one patient.

Conclusion

Complete absorption of a bioabsorbable interference screw is long, increasing the risk of developing intra-osseous tibial cysts during this period. The development of new materials with improved absorption properties is needed.

Level of evidence

IV—Retrospective study.

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

Similar content being viewed by others

References

  1. Arama Y, Salmon LJ, Sri-Ram K, Linklater J, Roe JP, Pinczewski LA (2015) Bioabsorbable versus titanium screws in anterior cruciate ligament reconstruction using hamstring autograft: a prospective, blinded, randomized controlled trial with 5-year follow-up. Am J Sports Med 43:1893–1901

    Article  PubMed  Google Scholar 

  2. Bach FD, Carlier RY, Elis JB et al (2002) Anterior cruciate ligament reconstruction with bioabsorbable polyglycolic acid interference screws: MR imaging follow-up. Radiology 225:541–550

    Article  PubMed  Google Scholar 

  3. Barber FA, Dockery WD, Hrnack SA (2011) Long-term degradation of a poly-lactide co-glycolide/β-tricalcium phosphate biocomposite interference screw. Arthroscopy 27:637–643

    Article  PubMed  Google Scholar 

  4. Bourke HE, Salmon LJ, Waller A, Winalski CS, Williams HA, Linklater JM et al (2013) Randomized controlled trial of osteoconductive fixation screws for anterior cruciate ligament reconstruction: a comparison of the Calaxo and Milagro screws. Arthroscopy 29:74–82

    Article  PubMed  Google Scholar 

  5. Busfield BT, Anderson LJ (2007) Sterile pretibial abscess after anterior cruciate reconstruction from bioabsorbable interference screws: a report of 2 cases. Arthroscopy 23:911.e1–911.e4

    Article  Google Scholar 

  6. Cox CL, Spindler KP, Leonard JP, Morris BJ, Dunn WR, Reinke EK (2014) Do newer-generation bioabsorbable screws become incorporated into bone at two years after ACL reconstruction with patellar tendon graft? A cohort study. J Bone Jt Surg Am 5:96244–96250

    Google Scholar 

  7. Dujardin J, Vandenneucker H, Bellemans J (2008) Tibial cyst and intra-articular granuloma formation after anterior cruciate ligament reconstruction using polylactide carbonate osteoconductive interference screws. Arthroscopy 24:238–242

    Article  PubMed  Google Scholar 

  8. 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 18:973–977

    Article  PubMed  CAS  Google Scholar 

  9. Faunø P, Christiansen SE, Lund B, Lind M (2010) Cyst formation 4 years after ACL reconstruction caused by biogradable femoral transfixation: a case report. Knee Surg Sports Traumatol Arthrosc 18:1573–1575

    Article  PubMed  Google Scholar 

  10. 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 41:1375–1379

    Article  PubMed  Google Scholar 

  11. 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 469:1082–1088

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. 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 27:1671–1678

    Article  PubMed  Google Scholar 

  14. Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Jt Surg Am 93:994–1000

    Article  Google Scholar 

  15. Konan S, Haddad FS (2009) A clinical review of bioabsorbable interference screws and their adverse effects in anterior cruciate ligament reconstruction surgery. Knee 16:6–13

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Mascarenhas R, Saltzman BM, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C et al (2015) Bioabsorbable versus metallic interference screws in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Arthroscopy 31:561–568

    Article  PubMed  Google Scholar 

  19. Nordenvall R, Bahmanyar S, Adami J, Stenros C, Wredmark T, Felländer-Tsai L (2012) A population-based nationwide study of cruciate ligament injury in Sweden, 2001–2009: incidence, treatment, and sex differences. Am J Sports Med 40:1808–1813

    Article  PubMed  Google Scholar 

  20. Ntagiopoulos PG, Demey G, Tavernier T, Dejour D (2015) Comparison of resorption and remodeling of bioabsorbable interference screws in anterior cruciate ligament reconstruction. Int Orthop 39:697–706

    Article  PubMed  Google Scholar 

  21. Radford MJ, Noakes J, Read J, Wood DG (2005) The natural history of a bioabsorbable interference screw used for anterior cruciate ligament reconstruction with a 4-strand hamstring technique. Arthroscopy 21:707–710

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  24. 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 14:215–220

    Article  PubMed  CAS  Google Scholar 

  25. Sprowson AP, Aldridge SE, Noakes J, Read JW, Wood DG (2012) Bio-interference screw cyst formation in anterior cruciate ligament reconstruction—10-year follow up. Knee 19:644–647

    Article  PubMed  Google Scholar 

  26. Tecklenburg K, Burkart P, Hoser C, Rieger M, Fink C (2006) Prospective evaluation of patellar tendon graft fixation in anterior cruciate ligament reconstruction comparing composite bioabsorbable and allograft interference screws. Arthroscopy 22:993–999

    Article  PubMed  Google Scholar 

  27. Thaunat M, Chambat P (2007) Pretibial ganglion-like cyst formation after anterior cruciate ligament reconstruction: a consequence of the incomplete bony integration of the graft? Knee Surg Sports Traumatol Arthrosc 15:522–524

    Article  PubMed  Google Scholar 

  28. 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 22:691.e1–691.e6

    Article  Google Scholar 

  29. Warden WH, Chooljian D, Jackson DW (2009) Ten-year magnetic resonance imaging follow-up of bioabsorbable poly-L-lactic acid interference screws after anterior cruciate ligament reconstruction. Arthroscopy 24:370.e1–370.e3

    Article  Google Scholar 

  30. Weiler A, Hoffman RFG, Stahelin AC, Helling HJ, Sudkamp NP (2000) Biodegradable implants in sports medicine—the biological base. Arthroscopy 16:305–321

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

Fonds de Dotation pour la Recherche Clinique en Orthopédie et Pathologie du Sport, 23 Rue Brochant, F-75017 Paris, FRANCE.

Author information

Authors and Affiliations

  1. Clinique du Sport Paris, 36, Boulevard Saint Marcel, 75005, Paris, France

    Romain Chevallier, Shahnaz Klouche, Antoine Gerometta, Yoann Bohu, Serge Herman & Nicolas Lefevre

  2. Institut de l’Appareil Locomoteur Nollet, 23, Rue Brochant, 75013, Paris, France

    Shahnaz Klouche, Antoine Gerometta, Yoann Bohu, Serge Herman & Nicolas Lefevre

Authors
  1. Romain Chevallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shahnaz Klouche
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antoine Gerometta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoann Bohu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Serge Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nicolas Lefevre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shahnaz Klouche.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

Ethics approval for this study was received from the Comité de Protection des Personnes Ile-de-France VI (CPP IDF VI), Hôpital La Pitié- Salpêtrière.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chevallier, R., Klouche, S., Gerometta, A. et al. Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 76–85 (2019). https://doi.org/10.1007/s00167-018-5037-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-018-5037-9

Keywords

Search

Navigation