Chronic reactive synovitis in patients undergoing ACL reconstruction and augmentation with tape-type sutures

Abstract

Introduction: Arthroscopic Anterior Cruciate Ligament Reconstruction (ACLR) with internal bracing and augmentation using tape-type sutures (TTS) has gained popularity due to its biomechanical advantages. However, concerns have emerged regarding chronic reactive synovitis, which can lead to graft failure and the need for revision surgery. The purpose of this research is to determine the prevalence of chronic reactive synovitis after TTS-reinforced ACLR.

Materials and methods: A retrospective review was conducted on a series of 84 patients who underwent arthroscopic ACL reconstruction with FiberTape or SutureTape augmentation, performed by a single surgeon in the year 2019.

Results: Of the 84 patients analyzed, 17 presented with at least two or more symptoms, including persistent instability, knee pain, swelling, stiffness, and local rise in temperature, within 3-45 months post-surgery. All required secondary surgery, either for synovectomy, and tape removal (8 cases) or revision ACLR (9 cases). Intraoperative histopathological analysis confirmed the diagnosis of reactive synovitis due to foreign body reaction. One year after the secondary surgery, all 17 knees showed satisfactory results. None of the patients experienced the pain, swelling, or instability that they had before the secondary surgery.

Conclusion: Foreign body synovitis was found in 17 symptomatic patients out of 84 (20.2 %) who underwent ACLR with TTS reinforcement one year. While this study does not establish a direct causal link between tape-type sutures and the development of synovitis, it emphasizes the significance of remaining vigilant for impending reactive synovitis as a complication, given the potential exposure of the knee to foreign body material.

Level of evidence: Level IV (Retrospective case series without a comparison group).

Keywords: ACL augmentation; ACL reconstruction; ACLR failures; Foreign body reaction; Reactive synovitis.

Fig. 1

MRI proven synovitis after ACLR with TTS augmentation (Fig. 1A – T2 sagittal section, Fig. 1B – T2 coronal section).

Fig. 2

Arthroscopic picture showing failure of the graft construct with synovitis.

Fig. 3

Histopathological image (low power 20× magnification) showing chronic hypertrophic synovitis with rare giant cells, consistent with a foreign body material.