Intra-articular Protrusion of Malpositioned Transfix Implant Following Anterior Cruciate Ligament Reconstruction

We report on a case of stiffness of the knee following reconstruction of the anterior cruciate ligament caused by a Transfix implant (Arthrex, Naples, FL) protruding into the medial retinacular area. After a skiing injury, a 56-year-old woman had a complete rupture of the anterior cruciate ligament along with a tear of the medial collateral ligament. She had an immediate anterior cruciate ligament reconstruction. A hinged brace was put on postoperatively. She presented to this institution 2 months after surgery with pain, stiffness, and decreased range of motion. Magnetic resonance imaging showed protrusion of the bioabsorbable implant in the medial retinacular area. Scar tissue was seen around the tip of the implant, medial retinacular area, and in the medial gutter. The terminal end of the protruding screw and the excess of scar tissue were removed arthroscopically. At the end of surgery, her on-table range of motion of the knee was 0° to 120°. She recovered well after physiotherapy and at the 3-month follow-up she was pain free and had virtually full flexion. The knee seemed stable and the medial collateral ligament showed signs of healing. Caution has to be exercised in the choice of size and angle of insertion of the Transfix implant.