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Case Report
 
Recurrent intraosseous ganglia in the proximal tibia following anterior cruciate ligament reconstruction using patella tendon bone autograft with a titanium interference screw: A case report
Aysha Rajeev1, James Henry2, Nanjappa Kashyap3
1Associate Specialist, Dept. of Orthopaedics and Trauma, Queen Elizabeth Hospital, Gateshead, UK.
2Consultant, Dept. of Histo Pathology, Queen Elizabeth Hospital, Gateshead, UK.
3Consultant, Dept. of Orthopaedics and Trauma, Queen Elizabeth Hospital, Gateshead, UK.

doi:10.5348/ijcri-2013-09-366-CR-10

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How to cite this article:
Rajeev A, Henry J, Kashyap N. Recurrent intraosseous ganglia in the proximal tibia following anterior cruciate ligament reconstruction using patella tendon bone autograft with a titanium interference screw: A case report. International Journal of Case Reports and Images 2013;4(9):502–506.


Abstract
Introduction: Intraosseous ganglia are benign cystic lesions and often multiloculated lesions located in the subchondral bone. These lesions are often asymptomatic but in cases located close to neurovascular structures or articular surfaces, they can be symptomatic, causing pain, neurologic dysfunction or articular fractures. We report a rare case of recurrent intraosseous ganglion following an anterior cruciate ligament (ACL) reconstruction in the proximal tibia. The ganglion developed after ten years of ACL reconstruction using patella tendon bone autograft fixed with a titanium interference screw. Initially the swelling mimicked the clinical and radiological features of a bone tumor.
Case Report: A 40-year-old Caucasian male underwent ACL reconstruction using patella tendon bone graft and a titanium interference screw fixation in the tibia. After ten years of surgery he noticed a lump in the proximal tibia at the site of tibial screw. The radiological features were unremarkable. He had excision of the swelling along with screw removal. The swelling recurred again within six months. The lump was excised again and tibial tunnel bone grafted. After 4 weeks the lump reappeared, magnetic resonance imaging scan showed a large cystic lesion in the proximal tibia. After taking the advice from the oncologist, the lesion was curetted and bone grafted. The cyst went on to heal completely in six months time.
Conclusion: The occurrence of intraosseous ganglion with absorbable interference screw has been reported. In our case report the intraosseous ganglion formed after using a titanium interference screw which has not been reported previously. It is also unique in the sense that the swelling recurred thrice and mimicked characteristics of a bone tumor.

Keywords: Recurrent, Intraosseous, Titanium interference screw, Mimic bone tumour


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Author Contributions
Aysha Rajeev – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
James Henry – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Nanjappa Kashyap – Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
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The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
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© Aysha Rajeev et al. 2013; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)