Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
Singapore Med J. 2013 Oct;54(10):e211-4. doi: 10.11622/smedj.2013195.
We report the case of a patient with a painful subcutaneous nodule, measuring 13 mm × 17 mm, at the pretibial graft aperture site, which presented two years after a successful anterior cruciate ligament reconstruction with an autologous hamstring graft. A bioabsorbable poly-L-lactide interference screw was used for graft fixation at the tibial aperture. The patient underwent surgical excision of the lesion and curettage at the tunnel aperture. Grossly, extruded fragments of the screw and a thick pseudocapsule of surrounding tissue were excised. There was no communication between the tunnel aperture and the knee joint. The graft was also intact. Histological analysis revealed fragments of the bioabsorbable material in association with fibrous and granulomatous chronic inflammatory cells. This was consistent with a foreign body reaction. The patient subsequently recovered and resumed preinjury level of activity. To the best of our knowledge, this is the first report describing a nodular granulomatous type reaction to foreign bioabsorbable poly-L-lactide screw material subsequent to an anterior cruciate reconstruction surgery.
我们报告了 1 例前交叉韧带重建术后 2 年出现疼痛性皮下结节的病例。患者采用自体腘绳肌腱移植物重建前交叉韧带，在胫骨开口处使用可吸收聚左旋乳酸（poly-L-lactide）干扰螺钉固定移植物。术后 2 年，患者在胫骨开口处移植物固定处出现 13 mm×17 mm 的疼痛性皮下结节。行病变切除术和隧道开口刮除术。大体上，切除了挤出的螺钉碎片和周围组织的厚假性包膜。隧道开口与膝关节之间没有相通。移植物也保持完整。组织学分析显示可吸收材料的碎片与纤维和肉芽肿性慢性炎症细胞有关。这符合异物反应的表现。患者随后恢复并恢复到受伤前的活动水平。据我们所知，这是首例描述前交叉韧带重建术后出现结节性肉芽肿样异物反应的病例，涉及到可吸收的聚左旋乳酸螺钉材料。
