Aims. Our purpose was to describe an unusual series of 21 patients with fungal osteomyelitis after an anterior cruciate ligament reconstruction (ACL-R). Methods. We present a case-series of consecutive patients treated at our institution due to a severe fungal osteomyelitis after an arthroscopic ACL-R from November 2005 to March 2015. Patients were referred to our institution from different areas of our country. We evaluated the amount of bone resection required, type of final reconstructive procedure performed, and Musculoskeletal Tumor Society (MSTS) functional score. Results. A total of 21 consecutive patients were included in the study; 19 were male with median age of 28 years (IQR 25 to 32). All ACL-R were performed with hamstrings autografts with different fixation techniques. An oncological-type debridement was needed to control persistent infection symptoms. There were no recurrences of fungal infection after median of four surgical debridements (IQR 3 to 6). Five patients underwent an extensive curettage due to the presence of large cavitary lesions and were reconstructed with hemicylindrical intercalary allografts (HIAs), preserving the epiphysis. An open surgical debridement was performed resecting the affected epiphysis in 15 patients, with a median bone loss of 11 cm (IQR 11.5 to 15.6). From these 15 cases, eight patients were reconstructed with allograft prosthesis composites (APC); six with tumour-type prosthesis (TTP) and one required a femoral TTP in combination with a tibial APC. One underwent an above-the-knee amputation. The median MSTS functional score was 20 points at a median of seven years (IQR 5 to 9) of follow-up. Conclusion. This study suggests that mucormycosis infection after an ACL-R is a serious complication. Diagnosis is usually delayed until major bone destructive lesions are present. This may originate additional massive reconstructive surgeries with severe functional limitations for the patients. Level of evidence: IV. Cite this article: Bone Joint Open 2020;2(1):3–8

Mucormycosis is an opportunistic infection that very occasionally causes osteomyelitis and avascular necrosis of bone. The infection may prove fatal if not diagnosed promptly. If early treatment is instituted the prognosis is good.

Introduction and Aims: Solitary osseous lesions of tuberculosis are uncommonly reported in children. Historically, bone lesions were predominantly of the multifocal and disseminated type. The aim of this paper is to describe the protean radiological manifestations of tuberculosis in sites other than the spine and synovium, and their resemblance to benign and malignant bone lesions. Method: Forty-nine children, aged 1–12 years with histologically confirmed osseous lesions of tuberculosis, were reviewed between 1984 and 2001. Symptoms ranged from two weeks to three months. There were a total of 59 lesions. Forty-three children had solitary, and six had multifocal lesions. Thirty lesions were in the metaphyses, six in the diaphyses and five in the epiphyses. The remainder were in the small and flat bones. Four basic patterns of bone lesions were seen. The majority were cystic in type (34), infiltrative (10), focal erosions (nine) and spina ventosa lesions (6). Several bone lesions resembled pyogenic and fungal osteomyelitis, osteoid osteoma, benign and malignant bone tumors. All patients had biopsy with curettage. Results: Follow-up ranged from nine months to 12 years (average 3.5). All lesions showed clinical and radiological healing by three to six months following anti-tuberculous treatment with rifampicin, isoniazid and pyrazinamide. Cystic lesions healed with slight marginal sclerosis in 12 patients. Growth disturbance was seen in six children with residual shortening of 1–3cm. Avascular necrosis of the femoral head was seen in three hips and coxa vara in two others. Six patients had joint contracture of 100–300. Good remodelling of cystic and spina ventosa lesions was seen in all patients. Conclusion: The lack of familiarity with the spectrum of bone lesions in tuberculosis can lead to delay in diagnosis. The clinical and radiological manifestations of tuberculosis appears to be changing. Destructive and infiltrative lesions are less commonly encountered. Solitary lesions can mimic various benign and malignant conditions. Biopsy is mandatory

Aims

This study aimed to investigate the clinical characteristics and outcomes associated with culture-negative limb osteomyelitis patients.