Publication:

Combined arthroscopic anterior cruciate ligament reconstruction and retrieval of an impacted intra-articular metallic fragment: a case of double mechanical derangement

Intra-articular foreign bodies in the knee are a less common and frequently overlooked cause of mechanical symptoms. In the presence of ligament injuries, intra-articular foreign bodies make up a complex clinical scenario that requires a comprehensive surgical approach. This clinical case describes a 27-year-old male patient with chronic knee instability and true mechanical locking following trauma. Radiographic evaluation revealed a high-grade rupture of the anterior cruciate ligament (ACL) and an impacted intra-articular metallic fragment on the weight-bearing surface of the medial femoral condyle (MFC). The patient underwent a combined arthroscopic procedure for the fluoroscopy-guided removal of the impacted intra-articular metallic body, followed by anatomical ACL reconstruction with a peroneus longus autograft. This clinical case demonstrates the idea of “dual” mechanical derangement, in which both translational instability and mechanical focal attrition coexist due to ACL injury and intra-articular foreign body, respectively. Early recognition and combined treatment of both conditions are crucial to avoid progressive chondral damage and subsequent joint degeneration.