[ musculoskeletal imaging ]

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FIGURE 1. Photograph of the patient demonstrating a nodu- FIGURE 3. T2-weighted magnetic resonance images (sagittal view on the left and axial view on the right) demonstrating cystic
lar mass over the tibial incision site from his previous anterior formation in the tibial tunnel from the previous anterior cruciate ligament reconstruction, with extension into the pretibial region
cruciate ligament reconstruction for the right knee (arrow). (arrows) and the fragmentation of the bioabsorbable interference screw.
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Tibial Cyst Formation Following Anterior

Cruciate Ligament Reconstruction
IBON LÓPEZ ZABALA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain.
SERGI SASTRE SOLSONA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain.
Journal of Orthopaedic & Sports Physical Therapy®

T
he patient was a 31-year-old
man who had undergone anterior
cruciate ligament (ACL) recon-
struction of the right knee 2 years prior
using a hamstring autograft, with tibial
fixation achieved using a bioabsorbable
poly-L-lactide interference screw. The
patient had returned to his preinjury ac-
tivity levels, which included recreational
running and soccer, without limitation
at 12 months following ACL reconstruc-
tion. However, he was now being evalu-
ated by an orthopaedic surgeon for the
insidious development of a subcutaneous
painful nodule over the tibial incision site
(FIGURE 1), which had progressively wors-
ened over the past month and interfered
with his ability to participate in run-
ning and soccer. The patient denied any
recent history of trauma or injury, and
there were no constitutional symptoms
or changes in his general health.
Physical examination revealed no ef-
fusion or erythema, full right knee range
of motion, and normal ligamentous and
meniscal testing. Palpation revealed lo-
calized pain and tenderness and the pres-
ence of a firm nodular mass over the tibial
incision site for the previous ACL recon-
struction. Further evaluation of the region
by radiography revealed widening of the
tibial tunnel (FIGURE 2, available online),
and magnetic resonance imaging revealed
cystic formation in the tibial tunnel and
the fragmentation of the bioabsorbable
interference screw (FIGURE 3).
Exploration of the tibial tunnel was
undertaken, and it was determined that
there was no communication with the
knee joint. Histological examination fur-
ther revealed a fibrohistiocytic reaction,
which was consistent with a response to
a foreign body.1 All of the remnants of the
bioabsorbable interference screw were
subsequently removed and the tibial tun-
nel was irrigated and curetted. Diagnos-
tic knee arthroscopy also revealed that
the ACL graft was intact. The patient’s
recovery was uneventful, and he success-
fully returned to recreational running and
soccer 3 months later. t J Orthop Sports
Phys Ther 2014;44(10):839. doi:10.2519/
jospt.2014.0411

Reference
1. Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN. Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction?
Clin Orthop Relat Res. 2011;469:1082-1088. http://dx.doi.org/10.1007/s11999-010-1580-5

journal of orthopaedic & sports physical therapy | volume 44 | number 10 | october 2014 | 839

44-10 Imaging-Zabala.indd 1 9/16/2014 5:08:40 PM