Treatment of recurrent infection at the tibial bone tunnel after anterior cruciate ligament reconstruction using a medial gastrocnemius muscle flap – A case report

INTRODUCTION AND IMPORTANCE: The incidence of postoperative infection after ACL reconstruction is reported to be 0.3 to 1.7%. Early debridement and complete removal of the artificial implant have been reported to be very important for complete recovery from postoperative infection after ACL reconstruction. Extra-articular infection of tibial tunnel post ACL reconstruction is a rare case and only a few cases are reported in the literature. The treatment for this lesion is not defined. CASE PRESENTATION: We report a 36-year-old case of recurrent infection at the tibial bone tunnel after ACL reconstruction. The treatment for the patient was debridement and then reconstruction using a medial gastrocnemius muscle flap. 9 months post-operative, there were no signs of infection at the surgical site and the knee joint. The patient reported no pain and was capable of walking without a crutch. CLINICAL DISCUSSION: Treatment of infection post ACL reconstruction can be accomplished by arthroscopic and surgical wound irrigation and debridement and antibiotic therapy. It was reported that debridement and then bone cement mixed with vancomycin and gentamycin loaded into the tibial bone tunnel was a good method for treatment of this lesion. If the treatment is not successful, a partial medial gastrocnemius muscle flap should be another choice for treatment of the recurrent infection at the tibial bone tunnel after ACL reconstruction. CONCLUSION: A partial pedicle medial gastrocnemius muscle flap is to be considered an alternative choice for treatment of the recurrent infection at the tibial bone tunnel after anterior cruciate ligament reconstruction. LEVEL OF EVIDENCE: A case report.