Extra-osseous pre-tibial cyst, complication of resorbable interference screws after anterior cruciate ligament reconstruction. About 53 patients.
Author(s):
Bohu Y. (France)
,
Bohu Y. (France)
Affiliations:
Lefevre N.
,
Lefevre N.
Affiliations:
Klouche S.
,
Klouche S.
Affiliations:
Chevallier R.
,
Chevallier R.
Affiliations:
Gerometta A.
,
Gerometta A.
Affiliations:
Herman Serge
Herman Serge
Affiliations:
ESSKA Academy. Bohu Y. 05/09/18; 209495; P07-480 Topic: Arthroscopic Surgery
Yoann Bohu
Yoann Bohu
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Abstract
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Objectives: Resorbable interference screws have gradually replaced the metal screws to fix the implants when reconstructing the anterior cruciate ligament (ACL). They reduce the risk of graft laceration, artifacts in postoperative imaging and do not require surgical ablation. However, they can induce the formation of symptomatic cysts resulting from the chemical resorption reaction. The objective of the study was to describe the clinical results of patients operated on for a pre-tibial cyst developed after ACL reconstruction.

Methods: A retrospective study included all patients operated in 2004-2016 with an extra-osseous pre-tibial cyst following an ACL reconstruction. The diagnosis was evoked clinically in case of pre-tibial pain in front of the incision, sometimes associated with a palpable subcutaneous nodule. The diagnosis was confirmed preoperatively on MRI (abnormal signal related to the tissues anterior to the tibia and focal marrow oedema around the tibial metaphysis) and postoperatively by histopathological examination of the cyst. The first surgical time was arthroscopic and exploratory more often associated with an anterior synovectomy of the knee. The second open surgery stage involved resection of the cyst, curettage of the tibia tunnel and then filling with cement, bank bone or bone substitutes. The histopathological examination of the cyst was requested. The main evaluation criterion was clinical knee normalization (non-painful, 0-120 mobility, stable, no effusion) at 6 months follow-up.

Results: Fifty-three patients had a pre-tibial cyst after a mean period of 4.6+/-3.1 (<1 to 19) years following the ACL reconstruction. The series consisted of 33 women and 20 men, mean age 35.3+/-9.9 years. ACL reconstruction was most commonly performed with hamstring tendons (83%) and a resorbable interference screw was used in all cases. Before surgery for the cyst, 16 patients had a new surgery on the same knee (including 5 meniscus surgeries, 3 Cyclops syndromes and 3 re-ruptures). The arthroscopic time was performed in 45 (84.9%) patients showing a cyclops of the foot of the ACL in 51.1% of the cases and a transplant intact in 40% of the cases.Peroperatively, the tibial screw appeared completely reabsorbed in 17% of the patients, fragmented in 41.5%. Histopathological examination revealed fibrosis, inflammatory granulomas and birefringent exogenous material in polarized light. At 6 months of follow-up, 81% of patients had no pain, 96.2% had normal mobility and 100% stable knee. At 2 years follow-up, one patient recidivated.

Conclusions: Resorbable interference screws can lead to the formation of pre-tibial cysts requiring surgical treatment. The total resorption of the interference screws is long exposing patients to the formation of pre-tibial cysts throughout this period. The development of novel materials with better degradation properties that do not induce undesirable local reaction is expected.

Keywords:
ACL reconstruction; pre-tibial cysts; Resorbable interference screws; screw resorption; surgery
Objectives: Resorbable interference screws have gradually replaced the metal screws to fix the implants when reconstructing the anterior cruciate ligament (ACL). They reduce the risk of graft laceration, artifacts in postoperative imaging and do not require surgical ablation. However, they can induce the formation of symptomatic cysts resulting from the chemical resorption reaction. The objective of the study was to describe the clinical results of patients operated on for a pre-tibial cyst developed after ACL reconstruction.

Methods: A retrospective study included all patients operated in 2004-2016 with an extra-osseous pre-tibial cyst following an ACL reconstruction. The diagnosis was evoked clinically in case of pre-tibial pain in front of the incision, sometimes associated with a palpable subcutaneous nodule. The diagnosis was confirmed preoperatively on MRI (abnormal signal related to the tissues anterior to the tibia and focal marrow oedema around the tibial metaphysis) and postoperatively by histopathological examination of the cyst. The first surgical time was arthroscopic and exploratory more often associated with an anterior synovectomy of the knee. The second open surgery stage involved resection of the cyst, curettage of the tibia tunnel and then filling with cement, bank bone or bone substitutes. The histopathological examination of the cyst was requested. The main evaluation criterion was clinical knee normalization (non-painful, 0-120 mobility, stable, no effusion) at 6 months follow-up.

Results: Fifty-three patients had a pre-tibial cyst after a mean period of 4.6+/-3.1 (<1 to 19) years following the ACL reconstruction. The series consisted of 33 women and 20 men, mean age 35.3+/-9.9 years. ACL reconstruction was most commonly performed with hamstring tendons (83%) and a resorbable interference screw was used in all cases. Before surgery for the cyst, 16 patients had a new surgery on the same knee (including 5 meniscus surgeries, 3 Cyclops syndromes and 3 re-ruptures). The arthroscopic time was performed in 45 (84.9%) patients showing a cyclops of the foot of the ACL in 51.1% of the cases and a transplant intact in 40% of the cases.Peroperatively, the tibial screw appeared completely reabsorbed in 17% of the patients, fragmented in 41.5%. Histopathological examination revealed fibrosis, inflammatory granulomas and birefringent exogenous material in polarized light. At 6 months of follow-up, 81% of patients had no pain, 96.2% had normal mobility and 100% stable knee. At 2 years follow-up, one patient recidivated.

Conclusions: Resorbable interference screws can lead to the formation of pre-tibial cysts requiring surgical treatment. The total resorption of the interference screws is long exposing patients to the formation of pre-tibial cysts throughout this period. The development of novel materials with better degradation properties that do not induce undesirable local reaction is expected.

Keywords:
ACL reconstruction; pre-tibial cysts; Resorbable interference screws; screw resorption; surgery
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