Sun Lei, Zhang Lei, Wang Kai, Wang Wei, Tian Min
Orthopaedic Center of PLA, The 88th Hospital of PLA, Tai'an City, Shandong Province, China.
Knee. 2012 Oct;19(5):728-31. doi: 10.1016/j.knee.2011.10.007. Epub 2011 Dec 30.
Fungal osteomyelitis is a very rare complication after anterior cruciate ligament (ACL) reconstruction associated with catastrophic consequences. Herein, we present a case of such disastrous complication after ACL reconstruction. A 23-year-old man developed fever, swelling and pain of the affected knee from 18 days after arthroscopic ACL reconstruction. Therefore, he underwent arthroscopic debridement, removal of the graft and internal fixators, irrigation and suction drainage, successively. Negative results for serial bacterial cultures and smear examinations are obtained. However, computer tomography and X-ray examination showed massive bone destruction at 48 days after ACL reconstruction. As the first open debridement was performed at 50 days after ACL reconstruction, fungal infection was diagnosed based on finding Aspergillus hyphae in pathologic examination of the debrided bone sample. After the final debridement, a 12-cm bone loss in the distal femur was treated by Ilizarov's bone transport. The patient got solid arthrodesis of the affected knee without clinical infection at a year after the initial operation. In addition, a review of the literature regarding case reports of fungal osteomyelitis after ACL reconstruction is presented.
真菌性骨髓炎是前交叉韧带（ACL）重建术后一种非常罕见的并发症，会带来灾难性后果。在此，我们报告一例ACL重建术后出现的这种灾难性并发症。一名23岁男性在关节镜下ACL重建术后18天，出现患膝发热、肿胀和疼痛。因此，他先后接受了关节镜下清创、移植物和内固定物取出、冲洗和负压引流。连续的细菌培养和涂片检查结果均为阴性。然而，计算机断层扫描和X线检查显示，ACL重建术后48天出现大量骨质破坏。由于在ACL重建术后50天进行了首次切开清创，根据清创骨样本病理检查发现曲霉菌丝，诊断为真菌感染。最后一次清创后，采用Ilizarov骨搬运技术治疗股骨远端12厘米的骨缺损。患者在初次手术后一年，患膝获得牢固融合，无临床感染。此外，还对ACL重建术后真菌性骨髓炎病例报告的文献进行了综述。
