Pretibial abscess associated with instrumentation-specific infection after anterior cruciate ligament reconstruction: A case report

Pretibial abscess is a rare but serious complication after anterior cruciate ligament (ACL) reconstruction. We report six cases of pretibial abscesses from 364 ACL reconstructions at our center between January 2022 and June 2023. Patients presented with poor wound healing, sinus tract formation, and magnetic resonance imaging showed fluid accumulation and bone marrow edema in the tibial tunnel but no deep infection. Bacterial cultures identified Pseudomonas aeruginosa and Burkholderia cepacia. Further investigation found contamination in the hexagonal reamers used for screw implantation, which was likely the infection source. This report highlights the importance of investigating instrument-specific infections when infection rates unexpectedly rise. LEVEL OF EVIDENCE: Level V.