RESUMO
INTRODUCTION AND IMPORTANCE: Chronic extra-articular infections of the tibial tunnel are rare, and there are only a few cases reported in the literature, so the diagnosis and management of these infections are still unclear. CASE PRESENTATION: We report a 36-year-old patient with chronic infection of the tibial tunnel after ACL reconstruction surgery. The patient was treated with arthroscopic debridement of the tibial tunnel and antibiotic cement filling. Seven months postoperative, there were no signs of infection at the surgical site and the knee joint. The patient has no pain, no joint instability, no limitation of range of motion, and no limitation in daily activities. CLINICAL DISCUSSION: The definitive diagnosis of chronic infection of the tibial tunnel should be carefully based on clinical signs, blood tests, and imaging to rule out combined intra-articular infections. The arthroscopic technique can be a favorable method to control and debride the inflammatory tissue of the tibial tunnel, limiting the recurrence rate postoperatively. CONCLUSION: Arthroscopic debridement and antibiotic-loaded cement can be considered an alternative to traditional surgical methods in the treatment of chronic infection of the tibial bone tunnel after ACL reconstruction. LEVEL OF EVIDENCE: A case report.
RESUMO
INTRODUCTION AND IMPORTANCE: Fabella syndrome is a rare cause of posterolateral knee pain. The definitive diagnosis and management of this syndrome remain unclear. CASE PRESENTATION: We report a case of a 19-year-old patient who is a Vietnamese professional football player. He presented with persistent pain in the posterolateral aspect of the knee joint for 12 months that was unrelated to trauma. He was treated conservatively for 6 months without any improvement in the previous hospital. He was diagnosed with fabella syndrome and underwent open surgery to remove the bone. Evaluation after surgery 12 weeks revealed the symptoms disappeared and he was able to return to practice. CLINICAL DISCUSSION: In order to diagnose fabella syndrome, the clinicians need to be vigilant and base on the clinical signs as well as imaging to exclude other causes of posterolateral knee pain. Conservative therapy is always the first choice of treatment although the recurrence rate is high, especially in professional athletes. If the initial conservative therapies failed, the fabella surgical removal surgery should be made in athletes. CONCLUSION: Fabella syndrome is a rare cause of posterolateral knee pain in professional athletes. The definitive diagnosis and management of this syndrome remain unclear. Our case shows that surgical removal of the bone fragments can be considered if failure after the initial conservative therapies.