Delayed onset bioabsorbable screw reaction, intact screw extrusion andPseudomonas aeruginosatibial tunnel osteomyelitis years after arthroscopic anterior cruciate ligament reconstruction using hamstring graft

Abstract

Postoperative reaction and infection after anterior cruciate ligament (ACL) reconstruction is a rare complication. We report two cases of bioabsorbable screw extrusion and Pseudomonas aeruginosa tibial tunnel infection in 17/18-year-old men, 2 and 4 years after ACL reconstruction, respectively. They underwent tibial tunnel debridement, removal of the still intact poly-L-D-lactic acid bioabsorbable screw and subsequent wound closure. Physical examination findings confirmed patency of the hamstring graft. Culture guided antibiotics were completed, and wounds healed unremarkably. Both returned to previous level of activity. Successful treatment is achieved through a logical sequence of management, as well as a multidisciplinary approach to prevent unnecessary secondary procedures and morbidity.

Biodegradable Bone Implants as a New Hope to Reduce Device-Associated Infections—A Systematic Review

“…The implants used in the selected studies are present in Table 1 and Table 2 . Different types and shapes, such as nails [ 68 , 69 , 70 ], screws [ 70 , 71 , 72 ], rods [ 73 , 74 , 75 , 76 , 77 ], wires [ 78 ], pellets [ 79 ], discs [ 80 ] and cylindrical or cubic scaffolds [ 81 , 82 , 83 , 84 , 85 , 86 , 87 ], were tested. A variety of materials were used, metals, polymers and calcium phosphates being among the most employed.…”

“…Apart from metallic devices, other studies used implants resulting from the mixture of different biodegradable polymers and calcium phosphates [ 71 , 79 , 81 , 83 , 84 , 85 , 86 , 87 , 89 ] or bone-like substitutes [ 82 , 85 ] as backbone materials, which could also incorporate macromolecules [ 81 , 89 ], nanoparticles [ 84 ] and silica [ 87 ]. Three implants followed a different pattern: two contained only a polymer within their core [ 80 , 85 ], and the other one was polymer-free [ 84 ].…”

“…Regarding in vivo studies, to pre-establish infection in animal models, the majority of the animals underwent inoculation of bacteria either at the moment of the implantation surgery [ 81 , 82 , 85 ] or before the surgery [ 83 , 86 , 87 , 89 ], generally some few weeks previously. Dumlao et al presented two human case studies reporting a PLDLA bioabsorbable screw extrusion and Pseudomonas aeruginosa tibial tunnel infection after 2 and 4 years of anterior cruciate ligament reconstruction [ 71 ]. P. aeruginosa that grow from patients’ tissue samples has shown to be susceptible to all antimicrobial drugs tested [ 71 ].…”

Use of biomaterials in scaphoid fracture fixation, a systematic review

“…Heterogeneity both between studies and between patients within study cohorts was noted. While the mean follow up time for patients was between one to two years, ongoing reports J o u r n a l P r e -p r o o f of delayed complications 2-4 years following bioabsorbable fixation devices in the literature 43 necessitates surgeons to remain vigilant for late phase reactions to occur in these patients.…”

Hematology and Culture Assessment of Cranially Implanted Rhesus Macaques (Macaca mulatta)

“…14 However, reports of implant-associated infections are numerous. 4,15,25,37,75 While rhesus macaques have been used as a model for chronic bronchitis induced by P. aeruginosa, 21 reports of this species as a cranial implant associated pathogen are absent from the current literature. Finally, like P. aeruginosa, Serratia marcescens is an opportunistic pathogen found in the environment and an important cause of nosocomial infections in human hospitals, 38 but its significance as a pathogen in rhesus macaques has yet to be determined.…”