Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature

Abstract

The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was treated with an autologous hamstring graft for chronic ACL instability brought on by a sport trauma. The patient developed iliotibial band friction syndrome 3 months after the operation. MRI showed incorrect positioning and a rupture of the femoral bio-absorbable cross-pin. The hamstring graft always had good fixation and did not produce instability of the knee. We removed the cross-pin fragment in a second surgery and the patient returned to her daily lifestyle after 3 weeks. The second case is a 52-year-old female with a painful and unstable knee due to a previous lateral meniscectomy and failure of an ACL reconstruction. We performed an ACL reconstruction with an autologous hamstring graft and a lateral meniscus transplantation. Some months after the procedure she also developed this syndrome. MRI showed the same features as shown in the first case and a second surgery was needed. To our knowledge this clinical and technical problem has not been previously described.

Anterior Cruciate Ligament (ACL)

“…There is usually no sign for knee instability. MR images show edema and contrast enhancement of the surrounding soft tissue and allow direct visualization of the fi xation device failure [ 22 ]. Often, surgery is needed for removal of offending fragment.…”

“…This friction syndrome affects, in the majority of cases, patients with hamstring grafts since the fi xation device for it might be larger and more superfi cial to the femoral cortex than in patients with bone-patellar-bone grafts. Incorrect positioning and rupture of the femoral bioabsorbable cross-pin might also be a cause for the friction syndrome [ 22 ]. There is usually no sign for knee instability.…”

“…Iliotibial band friction syndrome typically occurs at the lateral aspect of the distal femur where the femoral transfi xion devices for reconstructed ACL grafts are located [ 22 ]. The iliotibial band courses over the device which causes infl ammation, pain, and structural changes to the iliotibial band.…”

Imaging of Anterior Cruciate Ligament Graft Reconstruction

“…Complete or partial discontinuity of the graft in both the coronal and sagittal planes is highly specifi c for diagnosing Hardware-related complications; A number of less common complications seen after ACL reconstruction include complications of the fi xation devices (5). Iliotibial band friction syndrome is a potential complication of ACL reconstruction with the use of transfi x device and endobutton (14). Partially dislodged or fragmented transfi x device or endobutton may contact the adjacent iliotibial band and cause frictional thickening or tearing (14,15).…”

“…Iliotibial band friction syndrome is a potential complication of ACL reconstruction with the use of transfi x device and endobutton (14). Partially dislodged or fragmented transfi x device or endobutton may contact the adjacent iliotibial band and cause frictional thickening or tearing (14,15).…”