Distal biceps brachii tendon repair complicated by a suture granuloma mimicking a soft-tissue sarcoma: a case report and review of the literature

Association of Quadriceps Tendon Harvest for ACL Reconstruction With Development of Osteochondritis Dissecans of the Patella in Pediatric Patients

Background

There are various reported complications after primary anterior cruciate ligament reconstruction (ACLR) necessitating additional surgery in skeletally immature patients, regardless of technique and autograft type.

Purpose

To analyze the rate and type of complications encountered with soft tissue quadriceps tendon autograft (QTA) for ACLR in patients ≤18 years as well as the overall rate of second surgery, unrelated to the use of the QTA.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 141 patients ≤18 years who underwent ACLR with a QTA and had minimum 6-month follow-up were included. All patients underwent ACLR by utilizing a full-thickness soft tissue QTA. Complications associated with the QTA harvest site and use of QTA were reported.

Results

The mean age of the included cohort (84 men, 57 women) was 14.8 ± 1.6 years. The average follow-up was of 2.0 ± 1.2 years. A total of 30 (21%) patients had a subsequent complication that required surgical intervention; in 11 (8%) patients, the complication was specifically associated with the use of a QTA, whereas in 19 (13%) patients, the complication was related to the ACLR. In addition, 13 (9%) patients underwent a contralateral ACLR procedure. Of the QTA-related complications, 2 patients developed osteochondritis dissecans (OCD)-like lesions in the superior aspect of the patella, 2 patients had injured their quadriceps extensor mechanism and required surgical repair, and 8 patients had a subsequent procedure to remove nonabsorbable sutures used for donor site quadriceps tendon closure. One of the patients who underwent the removal of nonabsorbable sutures also had an arthroscopic debridement of patellar chondral damage.

Conclusion

We reported complications encountered with soft tissue QTA for ACLR. The complication rate for QTA harvest was 8%. However, given that the removal of nonabsorbable sutures from the donor site was caused by the surgical technique used, the revised nonsuture-related complication rate for QTA graft harvest was 2%. Although the use of a QTA has recently gained popularity due to its high return-to-sport and low graft-failure rates, surgeons should be aware of the complications associated with using this graft type.

Inflammatory reaction to suture materials after flexor tendon repair. A retrospective study of 594 patients

We report granuloma formation after using FiberWire^® for flexor tendon repairs. Four subcutaneous granulomas were identified in 115 patients with FiberWire^® core sutures, none in 426 with braided polyester. Foreign body reactions were found in the granuloma cases. We suggest early suture removal if this specific complication is encountered.

MRI findings of chronic distal tendon biceps reconstruction and associated post-operative findings

Rupture of the distal biceps tendon is becoming increasingly diagnosed due to an active aging population and an increase in diagnostic imaging opportunities. While physical exam may help in diagnosis, magnetic resonance imaging (MRI) is particularly useful in evaluating chronic rupture. Although partial tears can be managed conservatively, the gold standard treatment for a chronic distal biceps tear is anatomic reinsertion with additional use of an allograft or autograft. No study has highlighted the normal appearance and postsurgical complications seen on MRI associated with allograft or autograft usage. Clinicians and radiologists may be unaware of the normal and abnormal post-operative imaging findings and their clinical relevance. The purpose of this manuscript is to discuss the epidemiology, clinical presentation, and preoperative MRI findings of distal biceps ruptures necessitating reconstruction, to explain distal biceps tendon surgical reconstruction technique with allograft or autograft usage, to display the normal and abnormal post-operative MRI findings, and to review the clinical outcomes associated with the procedure.

Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination

The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.

Sterile Abscess with Subsequent Iatrogenic Draining Sinus Tract Formation 3 Years After FiberWire and ENDOBUTTON Distal Biceps Brachii Tendon Repair: A Case Report

CASE

We report a case of a sterile abscess with subsequent sinus tract formation mimicking infection 3 years after uncomplicated distal biceps brachii tendon repair with FiberWire suture in a 42-year-old man. The preoperative workup for infection was unremarkable. Intraoperative culture specimens confirmed the absence of infection. Excision of the sinus tract and FiberWire-ENDOBUTTON construct was curative. At the 1-year follow-up, there had been no recurrence of symptoms.

CONCLUSION

Foreign-body inflammatory reactions should be considered in the differential diagnosis of patients with apparent infection with a history of FiberWire suture fixation and negative serologic workup.

A delayed foreign body granuloma associated with polypropylene sutures used in tendon transfer. A case report

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Delayed suture reactions are rare.

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We present an unusual case of foreign body granuloma to polypropylene.

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Differential diagnosis and management are discussed.

Introduction

A delayed foreign body reaction to polypropylene sutures has not been previously reported following tendon repair.

Presentation of case

A 12-year old boy underwent tendon transfer. Tendon repair was done using polypropylene sutures. Five months later, a slowly growing granuloma was seen at the tendon repair site. Skin testing did not show an allergic reaction to the suture. Excision of the granuloma and removal of sutures were curative. Histology confirmed a foreign body granuloma.

Discussion

A mass developing several months at the site of tendon repair indicates either an allergic or foreign body reaction to the suture. Skin testing (for allergy) and histological examination of the mass differentiate allergic from foreign body reactions.

Conclusion

We report on a rare case of a giant granuloma caused by a delayed foreign body reaction to polypropylene sutures used in tendon repair.