Massive Bone Loss from Fungal Infection after Anterior Cruciate Ligament Arthroscopic Reconstruction


Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Correspondence to D. Luis Muscolo MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his institution has approved the reporting of this case report and that all investigations were conducted in conformity with ethical principles of research.

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Supplementary material 1 Video 1. A 29-year-old man had a fungal infection after ACL reconstruction. The video shows the final reconstruction after infection control. The cement spacer was resected, the cavitary bone defect was reconstructed with morselized allograft, and the structural defect was reconstructed with a hemicylindrical allograft. (MPG 25273 kb)

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Muscolo, D.L., Carbo, L., Aponte-Tinao, L.A. et al. Massive Bone Loss from Fungal Infection after Anterior Cruciate Ligament Arthroscopic Reconstruction. Clin Orthop Relat Res 467, 2420–2425 (2009).

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  • Anterior Cruciate Ligament
  • Fungal Infection
  • Anterior Cruciate Ligament Reconstruction
  • Septic Arthritis
  • Hamstring Autograft