PMC5661094_01
Clinical photos of the pretibial swelling and mass that is noted at the proximal aspect of the incision.
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fig1
The patient began to notice localized swelling in the proximal medial tibia at the proximal end of the prior incision (Figure 1).
(a) Axial slice of the MRI demonstrating the pretibial fluid collection in continuity with the orifice of the tibial tunnel. (b) T2 sagittal image demonstrates an intact ACL graft with adjacent tibial bone marrow edema. (c) T2 coronal image again demonstrates the pretibial fluid collection in continuity with the tibial tunnel and proximal tibial edema.
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fig2
Additionally, there was bone marrow edema of the proximal tibia (Figure 2).
(a) Intact ACL graft. (b) Grade 2 chondral changes in the medial face of the patella. (c) Intact articular cartilage of the medial tibial plateau, no tearing in the medial meniscus. (d) Grade 1 and 2 changes on the central aspect of the lateral tibia plateau.
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fig3
The lateral femoral condyle cartilage was normal (Figure 3).
(a) The pretibial soft tissue mass demonstrates direct communication with the tibial tunnel. (b) The tibial tunnel is well visualized after removal of the soft tissue mass. There is a lack of soft tissue deep to the skin, which prompted the sartorial fascia transfer over the exposed bone.
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fig4
The mass was found to communicate with the tibial tunnel (Figure 4(a)). Given the soft tissue defect in the area of the tibial tunnel (Figure 4(b)) the sartorial fascia was elevated and transferred proximally to cover the tibial tunnel to provide additional soft tissue coverage under the skin incision.
Representative low power view of sampled fibrous tissue with acute and chronic inflammation.
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fig5
Pathologic specimen from the tibial tunnel is shown in Figure 5.
(a) T2 axial slice of the MRI demonstrating resolution of the pretibial fluid collection. (b) T2 sagittal image demonstrates an intact ACL graft resolution of tibial bone marrow edema. (c) T2 coronal image again demonstrates resolution of pretibial fluid collection and proximal tibial edema.
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fig6
An MRI at the 4-month time period of her right tibia is shown in Figure 6 and demonstrated clearance of the infection.