Pretibial cyst formation after anterior cruciate ligament reconstruction using auto hamstring grafts: two case reports in a prospective study of 89 cases

doi:10.1016/S0730-725X(00)00207-1

Magnetic Resonance Imaging

Volume 18, Issue 8, October 2000, Pages 973-977

https://doi.org/10.1016/S0730-725X(00)00207-1 Get rights and content

Abstract

Eighty-nine cases after anterior cruciate ligaments (ACL) reconstruction were followed prospectively with magnetic resonance imaging (MRI). The patients were examined using axial and sagittal MRI at least twice during the postoperative evaluation of reconstructed ACL. Two cases of pretibial cyst formation were observed. At the time of cyst formation, neither patient had any subjective or objective evidence of knee instability. The cyst of one case communicated with the intra-articular. The minimum follow-up period after the surgical excision was 9 months, with no evidence of recurrence. We might speculate that the critical period for cyst formation in both patients occurred at less than 12 months after their ACL reconstruction. We concluded that the cyst formation was most likely due to incomplete graft tendon incorporation within the osseous tunnel.

Introduction

Recently, reconstructive surgery for a torn anterior cruciate ligament (ACL) has produced good results due to improvement in surgical methods, and the reconstructed ACL can be evaluated with magnetic resonance imaging (MRI) and with a KT-arthrometer etc. [1], [2]. In particular, MRI examinations have provided valuable information regarding the reconstructed ACL [3], [4], [5]. For example, re-injury, roof or wall impingements, and the remodeling process of the grafts can now be visualized [6], [7]. We performed a prospective evaluation of reconstructed ACLs using axial and sagittal MR images, because these images were thought to be suitable for evaluating ACL grafts. Our previous paper [8] showed that the incorporation of the grafted tendons into the intraosseous tunnel of ACL occurred from the seventh to twelfth months after surgery, as supported by MRI evidence.

We have experienced rare complications in the tibial tunnel at one year after the ACL reconstruction. In two cases, we found cyst formation in the tibial tunnel with autograft ACL reconstructions in our prospective MRI study. To our knowledge, there have been only a few reports on cyst formation in the tibial tunnel of a reconstructed ACL; previous reports have documented only nine cases of cyst formation in the pretibial tunnel after ACL reconstruction without instability [9], [10], [11]. Five cases involved autografts, and 4 cases involved allografts. Since these reports were all retrospective studies, they could not describe when and how the cyst were formed. We experienced two cases of cyst formation in a prospective study of reconstructed ACLs. These cases were recognized by MRI scanning at twelve months after ACL reconstruction, and neither case had any detectable cyst formation at six months after surgery.

The objective of this report was to discuss the cause of cyst formation in the tibial tunnel after ACL reconstruction.

Section snippets

Materials and methods

We followed 89 patients in this prospective study. All patients were reconstructed with auto semitedinosus/gracilis tendons using endoscopic and Endobutton techniques, from May 1995 to April 1998. The senior authors (MO and YS) performed same procedure for 89 patients with ACL deficient knees. All patients had undergone a rehabilitation program. All of the patients were examined using axial and sagittal MRI views at least twice during the post-operative evaluation of their ACL reconstruction.

Discussion

There have been a few reports on subcutaneous pretibial cyst extruding from the distal tibial tunnel after an ACL reconstruction without resulting instability. Victroff et al. [11] reported that this complication was a result of incomplete incorporation of the allograft into the osseous tunnel, with residual graft necrosis allowing the synovial fluid to be transmitted through the tunnel. They concluded that cyst formation was secondary to bone ingrowth, and was attributable to an inability to

Acknowledgements

The authors would like to thank Masashi Osedo, MD, for his kind assistance and Shigeyuki Kato for his great help.

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Pretibial cyst formation after anterior cruciate ligament reconstruction using auto hamstring grafts: two case reports in a prospective study of 89 cases

Abstract

Introduction

Section snippets

Materials and methods

Discussion

Acknowledgements

Magnetic Resonance Imaging

Arthroscopy

Arthroscopy

Arthroscopy

Serial magnetic resonance imaging of hamstring anterior cruciate ligament autografts during the first year of implantation. A preliminary study

American Journal of Sports Medicine

Reconstruction of the anterior cruciate ligament using allogeneic tendon. Long-term followup

American Journal of Sports Medicine

Signal intensity measurements of unimpinged anterior cruciate ligament grafts

Radiology

A rationale for predicting anterior cruciate graft impingement by the intercondylar roof. A magnetic resonance imaging study

American Journal of Sports Medicine