A case of delayed recurrent hemarthrosis after posterolateral reconstruction of the knee with a staple fixation at the lateral femoral epicondyle

We present a case of delayed recurrent hemarthrosis after posterolateral reconstruction of the knee with staple fixation of the tendon graft at the lateral femoral condyle. A 20-year-old man had undergone a reconstructive surgery of the knee with allogeneic Achilles tendon aimed to reinforce lateral collateral ligament and popliteofibular ligament. At 4 months after surgery, recurrent swelling of the operated knee after minor exertion developed. The radiographs showed prominent staples at the lateral side of lateral femoral condyle. The arthroscopy revealed that the staples were salient intra-articularly at lateral gutter of the knee, and the adjacent lateral capsule seemed abraded, through which the longitudinal fibers of iliotibial band were seen. Iatrogenic iliotibial band syndrome owing to the prominent staple was speculated. The staples were removed under arthroscopic guidance, and there has been no recurrence thereafter. A staple fixation over bony prominence is not advisable and the interference screw might be a better alternative method of fixation.