Friday, 06 June 2008
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Difficult patient.
Pt. with instability due to previous meniscal injury, presented with knee effusion after a separate injury and exam showed positive Lachman and anterior drawer.
A reconstruction was performed using hamstring graft,1 day post op pt. suffered a fall and was found to have ruptured the graft and also was noted that a fracture had ocurred of the tibial plateau in the area of the screw. A revision was done and 50% of the graft was saved. The defect in the tibia was filled with hydroxyapatite.
Pt.had good post revision and repair evolution, but now 8 months post op is experiencing pain in the same area of the tibia (fracture site) after a direct trauma to the knee. Also appears that the remaining graft was damaged as anterior translation is increased.
A bone scan was performed to rule out infection of the tibia.Results were suggestive of infection due to high uptake in the tibia in the affected site,also noted in the area of the hydroxyapatite bone graft (possibly due to osteo activity?).
Radiologist suggested a CT. Labs are negative for inflammation or infection.
Any ideas for the findings on the BS?
Could it be a sign of rejection or possibly deterioration of the graft?Pt claims to have same quality of pain in same area as experienced with the fracture although Rx shows the fracture is healed,and the pt was pain free and progressing well with PT for many months.
Any ideas?
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