Granuloma formation associated with patellar tendon necrosis in response to Ethibond confirmed by histopathological examination

BMJ Case Rep. 2018 May 12:2018:bcr2017222854. doi: 10.1136/bcr-2017-222854.

Abstract

The aim of this study is to describe a case of delayed granuloma formation associated with tendon necrosis in response to Ethibond confirmed by histopathological examination and to review and discuss the related literature. A 40-year-old woman underwent a patellar tendon repair with Krakow-like #5 Ethibond sutures. Four years after the repair, she noticed progressive soreness with knee extension and swelling. An ultrasound examination revealed a proximal partial patellar tendon rupture. Based on these findings, the patient was advised to undergo surgical intervention due to a diagnosis of re-rupture. Tendinosis, fibrosis and necrosis scar tissue surrounding the previous suture were observed and excised, and samples were sent for histopathological and microbiological examination. Stripping of the patellar paratenon was performed. Surprisingly, a giant cell foreign body reaction surrounding the synthetic refringent material, as well as polymorphonuclear cells surrounding the necrotic tendon, was reported.

Keywords: knee injuries; orthopaedics; tendon rupture; trauma; unwanted effects / adverse reactions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Female
  • Foreign-Body Reaction / pathology
  • Giant Cells, Foreign-Body / pathology
  • Granuloma, Giant Cell / pathology*
  • Granuloma, Giant Cell / surgery
  • Humans
  • Knee Injuries / surgery*
  • Magnetic Resonance Imaging
  • Necrosis / diagnostic imaging
  • Necrosis / pathology*
  • Necrosis / surgery
  • Patellar Ligament / diagnostic imaging
  • Patellar Ligament / pathology*
  • Patellar Ligament / surgery
  • Plastic Surgery Procedures / adverse effects*
  • Polyethylene Terephthalates / adverse effects*
  • Postoperative Complications / immunology
  • Postoperative Complications / pathology*
  • Postoperative Complications / surgery
  • Sutures / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Ethibond
  • Polyethylene Terephthalates