Chondrolysis of the tibial plateau caused by articular aspergillosis after ACL autograft reconstruction: management with a fresh osteochondral allograft: a case report.

A rthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) is a common and effective method for treatment of anterior knee instability following ACL injury. Annually, an estimated 250,000 ACL injuries are diagnosed and approximately 100,000 ACL reconstructions are performed in the United States. Chondrolysis is an extremely rare but devastating complication following ACL reconstruction. It is characterized by complete destruction of the articular cartilage and a profound inflammatory response consisting of pain, swelling, and loss of joint motion. The differential diagnosis includes osteonecrosis, direct trauma related to the injury or to the surgical procedure, infection, an adverse reaction to pharmacological agents (including local anesthetic infusions), and unknown causes. Infection after arthroscopic ACL reconstruction is rare: its incidence has been reported as 0.14% to 1.7%. The most common causative organisms are Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus. When tissue allografts have been used for ACL reconstruction, other organisms such as Peptostreptococcus, Klebsiella, Enterobacter, and Clostridium species as well as gram-negative bacilli have been implicated. Although infrequent, infection can be a devastating complication that leads to septic arthritis, chondrolysis, osteomyelitis, osteochondral destruction, and, in rare cases, death. We describe a case of medial tibial plateau osteochondral destruction secondary to an Aspergillus flavus fungal infection in an immunocompetent thirteen-year-old girl who had undergone elective ACL reconstruction. The patient and her parents were informed that data concerning the case would be submitted for publication, and they provided their consent. To the best of our knowledge, a case of Aspergillus fungal arthritis following ACL reconstruction has not been previously reported. Furthermore, salvage options outlined in the literature have been limited to primary arthrodesis, prosthetic reconstruction, use of allograft-prosthesis composites, and use of nonarticular allograft void fillers. We describe a salvage technique in which the medial tibial plateau, the associated articular cartilage, and the medial meniscus were successfully replaced with a fresh osteochondral/ meniscus allograft.