title: Early postoperative transtibial articular fistula formation after anterior cruciate ligament reconstruction: a review of three cases.
abstract: BACKGROUND
  This is a retrospective case report of three cases with an early postoperative transtibial fistula after anterior cruciate ligament reconstruction (ACL).
  
  
  METHODS
  The patients had undergone ACL reconstruction and complained of fluid drainage through the not-healed wound or swelling localized on the anteromedial aspect of the ipsilateral proximal tibia during the early postoperative. Magnetic resonance imaging showed a multilocular fluid-filled cyst arising from the distal hole of the tibial bone tunnel. Open resection of the fistula and the cyst was performed in all cases and communication between the tibial tunnel and the joint space was confirmed. During revision surgery the distal hole of the tibial tunnel was covered with a fascio-periosteal flap.
  
  
  RESULTS
  All wounds healed without complications. There was no recurrence of drainage or cyst formation. At 2 years follow-up the knee function was normal and was not affected by the complication in any of the patients. Early postoperative transtibial fistulae after ACL reconstruction are rare complications that clinically present either as anterior tibial cysts or persistent wound drainage. Surgical treatment is required, and some delay in the rehabilitation routine is required, but the final outcome is not affected.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Universitario Ramón y Cajal, Cta Colmenar Km 9.100, 28034, Madrid, Spain, drdiazheredia@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Díaz Heredia
authors.forename: M A
authors.initials: MA
authors.lastname: Ruiz Iban
authors.forename: R
authors.initials: R
authors.lastname: Cuéllar Gutiérrez
authors.forename: R
authors.initials: R
authors.lastname: Ruiz Diaz
authors.forename: I
authors.initials: I
authors.lastname: Cebreiro Martinez del Val
authors.forename: L
authors.initials: L
authors.lastname: Turrion Merino
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011184:Postoperative Period; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult