Open Access
The Journal of Knee Surgery Reports 2015; 1(01): 012-016
DOI: 10.1055/s-0034-1370900
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Femoral Distal Mucormycosis after a Knee Meniscectomy

Carlos Garces Zarzalejo
1   Department of Orthopeadic Surgery, Valdecilla University Hospital, Santander, Cantabria, Spain
,
Michel Fakkas Fernandez
1   Department of Orthopeadic Surgery, Valdecilla University Hospital, Santander, Cantabria, Spain
,
Marta Fernandez Sampedro
2   Division of Infectious Diseases, Department of Medicine, Valdecilla University Hospital, Santander, Cantabria, Spain
,
Luis Estelles Marcos
1   Department of Orthopeadic Surgery, Valdecilla University Hospital, Santander, Cantabria, Spain
,
Marian De la Red Gallegos
1   Department of Orthopeadic Surgery, Valdecilla University Hospital, Santander, Cantabria, Spain
,
Sergio Garcia Granja
1   Department of Orthopeadic Surgery, Valdecilla University Hospital, Santander, Cantabria, Spain
› Author Affiliations
Further Information

Publication History

10 April 2013

31 December 2013

Publication Date:
26 February 2014 (online)

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Abstract

Although various complications have been reported following knee arthroscopy, postoperative infections are rare. The pathogens most commonly isolated in infections associated with arthroscopic surgery are Staphylococcus species. Fungal osteomyelitis remains a very unusual complication, but it is associated with severe consequences when it does occur. Only 10 cases of fungal osteomyelitis following anterior cruciate ligament (ACL) reconstruction have been reported in the literature. To our knowledge, the case we report on here is the first mycotic infection following a routine arthroscopic knee procedure—a partial meniscectomy. Diagnosis of this type of complication represents a great challenge to orthopedic surgeons and physicians. Fungal infections should be suspected in patients with persistent signs and symptoms of septic arthritis following an arthroscopic procedure, despite conventional cultures consistently positive for bacteria, and normally adequate treatment using specific antibiotic therapy. Positive fungal cultures and the presence of mycotic structures in histopathologic samples confirm the diagnosis. Incorrect and delayed diagnoses are common, so extensive bone destruction is frequently found. For a successful resolution of fungal osteomyelitis, two-stage procedures including radical debridement and prolonged antifungal treatment should be employed. The reconstructive stage may often require complex surgical techniques, including revision of total knee arthroplasty or arthrodesis.