Allergic reaction to biodegradable interference poly-L-lactic acid screws after anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.
We report a case of a systemic allergic reaction to biodegradable poly-L-lactic acid (PLLA) interference screws after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone graft. A 30-year-old patient complained of certain symptoms, such as an inability to focus mentally, rash on the right femur, chronic fatigue, decreased sex drive, and localized alopecia, 3 months after ACL reconstruction in the right knee. Two biodegradable PLLA interference screws had been used for proximal and distal graft fixation. Allergy testing showed a value of 7 in PLLA antigen. After removal of 1 screw in August 2000, the patient reported marked improvement, but some symptoms remained. In July 2001 he underwent arthroscopic revision ACL reconstruction with hamstrings via an implant-free technique with intensive debridement of the tunnels and removal of all scar tissue and screw rests. All symptoms disappeared, and the PLLA antigen number fell from 3 to "concentrate" 2 months postoperatively.
First Orthopaedical Department, University of Athens, General University Hospital ATTIKON, Haidari, Greece. D.S.Mastrokalos@otenet.gr
Dimitrios S
DS
Mastrokalos
Hans H
HH
Paessler
D020341:Absorbable Implants / Q000009:adverse effects*; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects*; D016025:Bone Transplantation / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D019344:Lactic Acid / Q000009:adverse effects*; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation; D011091:Polyesters; D011108:Polymers / Q000009:adverse effects*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)