Inflammatory response to intraarticular suture placement in anatomic anterior cruciate ligament double-bundle reconstruction: A case report

Rearthroscopy after anterior cruciate ligament (ACL) as the result of significant postoperative inflammation lacking bacterial or fungal infection after single bundle reconstruction are commonly reported in techniques using artificial ACL augmentation devices. Recently, novel techniques of ACL double-bundle reconstructions were introduced. However, most of these techniques require a significant modification in the graft preparation of the semitendinosus and the gracilis tendon. Compared with ACL single-bundle reconstructions, the prepared tendon grafts for ACL double-bundle reconstructions are much shorter since the grafts are not only used for restoration of the anteromedial bundle but also for the posterolateral bundle. Therefore, the sutures of the tibial suture-postfixation may be located intra-articularly. We present a case of an intra-articular location of the tibial fixation suture causing a significant synovitis 3 weeks after anatomic ACL double bundle reconstruction. The inflammation was successfully treated by arthroscopic debridement and irrigation. The suture and the post-fixation were preserved because of incomplete incorporation of the graft at the time of rearthroscopy.