2Assistant Professor of Orthopedic Surgery,
Orthopedic Research Center,
Mashhad University of Medical Sciences, Mashhad, Iran
3Orthopedic Surgeon, Mashhad University of Medical Sciences, Iran
A 25 year-old man presented with pain, swelling, and intermittent drainage from distal lateral aspect of his left knee three months after undergoing isolated ACL reconstruction with arthroscopic hamstring autograft and endobottom technique. His surgeon at that time tried to eliminate the pathology through arthroscopic wash out in two attempts. However, the pain, edema, and discharge recurred after a year of being symptom free. The patient underwent imaging assessment and anteroposterior and lateral radiographs demonstrated a sclerotic area beneath the femoral condoyle in femoral tunnel and a fusiform sclerotic area in the lateral aspect of femoral midshaft. Magnetic Resonance Imaging revealed necrotic tissue with bone edema consistent with the sclerotic area in radiographs indicating micro abscesses and osteomyelitis. A diagnosis of femoral chronic osteomyelitis was made and the patient underwent arthroscopic drainage and washout, followed by open surgery for diaphysial femoral osteomyelitis. Rehabilitation was started and after six months the patient returned to his work .
Burke WV, Zych GA. Fungal infection following replacement of the anterior cruciate ligament: a case report. J Bone Joint Surg Am. 2002; 84(3):449-53.
Frank M, Schmucker U, David S, Matthes G, Ekkernkamp A, Seifert J. Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2008; 16(1):71-4.
McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J. Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med. 1999;27(5):562-70.
Muscolo DL, Carbo L, Aponte-Tinao LA, Ayerza MA, Makino A. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction. Clin Orthop Relat Res. 2009; 467(9):2420-5.
Rademacher G, Stengel D, Paris S, Cramer J, Mutze S. Diagnostic efficacy of gadodiamide-enhanced dynamic examination technique in comparison to conventional magnet resonance tomography in exacerbated chronic osteomyelitis. Rofo. 2003; 175(10):1417-23.
Schollin-Borg M, Michaelsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy. 2003; 19(9):941-7.
Sun L, Zhang L, Wang K, Wang W, Tian M. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature. Knee. 2012; 19(5):728-31.
Viola R, Marzano N, Vianello R. An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy. 2000; 16(2):173-7.
Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy. 2009; 25(3):243-9.
Wilkins RM, Hahn DB, Blum R. Bread mold osteomyelitis in the femur. Orthopedics. 2009; 32(5):362.
Williams RJ, 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med. 1997; 25(2):261-7.