Management of Chronic Transtibial Articulocutaneous Fistula After All-Inside ACL Reconstruction: A Case Report.

CASE: A 29-year-old man presented 2 years after anterior cruciate ligament (ACL) reconstruction by autologous semitendinosus graft and suspensory fixation on both tibial and femoral sides for chronic drainage of clear fluid from an anteromedial wound at the site of the tibial tunnel with a visible sinus tract. Magnetic resonance imaging showed a transtibial articulocutaneous fistula. The patient was treated by tunnel debridement, impaction bone grafting, bioresorbable interference screw, and cement to fully seal the tunnel. The surgery was successful with good clinical outcomes for recurrence and knee stability. CONCLUSION: Communicating transtibial articulocutaneous fistulas are rare complications after ACL reconstruction. Tunnel debridement and filling with graft material affected by an interference screw seem to be an effective method for dealing with such a clinical scenario.

Outcome at 3 to 5 years of a treatment algorithm for rotator cuff tears in an elderly population.

The purpose of this study is to evaluate the results of a conservative approach of rotator cuff tears in an elderly population at 3 to 5 years of follow-up. Prospective comparative study. All patients started with a program of exercises of at least 1 to 3 months. When no satisfying results for pain relief and ADL were achieved, surgery for cuff tear repair was offered. Patients were contacted after 3 to 5 years for evaluation by questionnaire, an ultrasound and a strength measurement exam. 97 patients (104 shoulders) with a mean age of 68,5 years were included. 47.1% of shoulders were treated conservatively whereas 52.9% switched to surgical treatment. Evaluation after 3 to 5 years showed no significant difference between type of treatment and post treatment test scores (Constant score, SF12v2, OSS and WORC). Delaying surgery for 3 months does not seem to influence outcome negatively.