chronic osteomyelitis in the femoral midshaft following arthroscopic acl reconstruction

a 25 year-old man presented with pain, swelling, and intermittent drainage from distal lateral aspect of his left knee three months after undergoing isolated acl reconstruction with arthroscopic hamstring autograft and endobottom technique. his surgeon at that time tried to eliminate the pathology through arthroscopic wash out in two attempts. however, the pain, edema, and discharge recurred after a year of being symptom free. the patient underwent imaging assessment and anteroposterior and lateral radiographs demonstrated a sclerotic area beneath the femoral condoyle in femoral tunnel and a fusiform sclerotic area in the lateral aspect of femoral midshaft. magnetic resonance imaging revealed necrotic tissue with bone edema consistent with the sclerotic area in radiographs indicating micro abscesses and osteomyelitis. a diagnosis of femoral chronic osteomyelitis was made and the patient underwent arthroscopic drainage and washout, followed by open surgery for diaphysial femoral osteomyelitis. rehabilitation was started and after six months the patient returned to his work .