Introduction: ACL reconstruction with PTFE grafts enjoyed a brief period of popularity approximately a decade ago but early failures led to the technique being largely abandoned for primary reconstruction. We present a case where a patient presented several years after initial reconstruction because of an increase in pain.

Case Report: A 43 year old man presented to the clinic because of an increase in knee symptoms without a specific history of trauma. He had previously undergone a PTFE reconstruction of his acl. X-rays at the time revealed a large, expanding cyst in his proximal tibia which was approximately 5x3x3cm.

Management: In view of the increasing bone loss it was decided to manage this case surgically. After thorough debridement of the cavity in the proximal tibia morcellised bone was grafted into the defect on the tibial side. The femoral side of the graft was removed but no further treatment was required. Histology of the lesion revealed copious amounts of PTFE debris.

Outcome: After 3 years of follow up the tibial graft has incorporated and radiologically the proximal tibia has consolidated well. Symptomatically the patient is improved and there have been no problems relating to instability.

Conclusion: Autologous grafting of the proximal tibia is a useful technique in this unusual circumstance. With the increase in synthetic graft use on the continent it is possible that more similar cases will present.