Nocardia nova Infection of Tibia Tenodesis Implant After Anterior Cruciate Ligament Reconstruction in an Immunocompetent Patient

Infection after anterior cruciate ligament reconstruction and Nocardia infection in immunocompetent hosts are rare events in isolation. This case report highlights the rare combination of these events in a 46-year-old healthy man who acquired a Nocardia nova infection of the tibia tunnel site after an anterior cruciate ligament reconstruction with peroneus allograft. He was successfully treated with tibial tenodesis screw removal, two surgical debridements, and 4 weeks of trimethoprim-sulfamethoxazole and meropenem, followed by 6 months of clarithromycin and original graft retention. This report will review the current antibiotic recommendations and surgical management of this challenging situation. Our case is unique in that the infection was isolated to the distal aspect of the tibial tunnel and did not spread into the entire knee joint, highlighting the importance of early debridement and irrigation in the operative suite when graft site infection is suspected.