Case Report: Fibroxanthoma: A Complication of a Biodegradable Screw

Mir Sadat-Ali MD, PhD, FRCS, D Orth, Quamar Azzam MBBS, MS, Mohammed Bluwi MBBS, SSC (Ortho), Abdallah S. Al-Umran MBBS, SSC (Ortho)
Case Report - Knee
Volume 468, Issue 8 / August , 2009

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Abstract

Background

Biodegradable interference screws in anterior cruciate ligament (ACL) reconstruction have gained popularity because of their similar or superior fixation strength in comparison to metallic interference screws and because they do not cause imaging artifacts and do not need to be removed.

Case Description

We report the case of a 23-year-old man who presented with slowly progressive firm swelling of 2 months’ duration at the site of the tibial tunnel 3 years after ACL reconstruction using a biodegradable interference screw. After curettage and débridement, the material was sent for histopathologic examination, which was reported as a fibroxanthoma.

Literature Review

Reported complications are osteolysis around the screw, allergic reaction, sterile abscess formation, ganglion cyst formation, and intraarticular migration. A fibroxanthoma consists of fibroblasts and mononuclear or multinucleated cells with large lipid-filled histiocytes (foam cells). The cells are negative for S-100 and keratin and positive for anti-human macrophage marker HAM-56.

Purposes and Clinical Relevance

Use of biodegradable screws is associated with high healing rates and low complication rates; however, awareness of their potential complications may help in early recognition and prevention of associated morbidity.

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