Aseptic arthritis after ACL reconstruction by Tape Locking Screw (TLS®): report of two cases

In Tape Locking Screw (TLS(®)) ligamentoplasty, transplant bone fixation uses polyethylene terephthalate (PET). We report two cases of aseptic arthritis following anterior cruciate ligament (ACL) reconstruction using this material. Diagnosis was founded on negative sampling and complete cure following arthroscopic lavage and synovectomy without curative antibiotherapy. This complication was also described with other synthetic materials used in this indication (Dacron, PFTE, carbon), and with PET as transplant material but never as bone fixation material. The physiopathological hypothesis is in terms of PET particle release in the suprapatellar bursa; sinking the strips into the bone as fully as possible on implantation could avoid impingement. Longer TLS(®) ligamentoplasty series with adequate follow-up will be needed in order to estimate the true incidence of this complication.

Pseudallescheria boydii knee arthritis in a young immunocompetent adult two years after a compound patellar fracture

Pseudallescheria boydii arthritis of the knee developed in a 32-year-old immunocompetent man 2 years after a compound patellar fracture contaminated with soil. No other potential portal of entry was identified, suggesting that the fungus remained latent for 2 years. Pseudallescheria arthritis often occurs after a prolonged latency period, causing minimal symptoms that contrast with the frequently severe radiological changes. Although this organism often shows limited sensitivity to most antifungal agents, our patient achieved a full recovery after surgical synovectomy and 6 months of itraconazole therapy (400 mg/ d). This case illustrates the importance of testing for fungi in patients with torpid arthritis, particularly when mild clinical symptoms contrast with severe bone and joint destruction.