{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:29:55Z","timestamp":1767356995710,"version":"3.48.0"},"reference-count":19,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,21]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>This report describes the case of a woman in her 40s who developed debilitating knee pain and instability 1 year after undergoing an anterior cruciate ligament reconstruction. MRI revealed a complex pathology, including marked widening of both the femoral and tibial bone tunnels, significant perigraft cyst formation, a complete posterior root tear of the medial meniscus with extrusion and a partial tear of the lateral meniscal root. This indicated a functional failure of the primary reconstruction, leading to secondary intra-articular damage. A staged surgical approach was planned with an open excision of the proximal tibial tunnel cyst with meticulous curettage of the tunnel walls, combined with an arthroscopic all-inside repair of the medial meniscus. Substantial bone loss was addressed with autologous iliac crest bone graft. The patient experienced an uneventful recovery with significant symptomatic improvement, evidence-based approach to managing complex postoperative anterior cruciate ligament reconstruction complications.<\/jats:p>","DOI":"10.1136\/bcr-2025-268853","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T09:45:12Z","timestamp":1764927912000},"page":"e268853","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Two-stage management of a large tibial tunnel cyst and secondary meniscal root tear after anterior cruciate ligament reconstruction"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9808-2945","authenticated-orcid":false,"given":"Atul","family":"John","sequence":"first","affiliation":[{"name":"Orthopaedics, St John\u2019s National Academy of Health Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akhil","family":"John","sequence":"additional","affiliation":[{"name":"Orthopaedics, Christian Medical College and Hospital Vellore, Vellore, Tamilnadu, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pothuri Rishi","family":"Ram","sequence":"additional","affiliation":[{"name":"Orthopaedics, St John\u2019s National Academy of Health Sciences, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe Joseph","family":"Cherian","sequence":"additional","affiliation":[{"name":"St John\u2019s Medical College Hospital, Bengaluru, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"2026010204251099000_18.12.e268853.1","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s40634-021-00356-9","article-title":"A comprehensive scoping review of tibial cysts after anterior cruciate ligament reconstruction","volume":"8","author":"Barbosa","year":"2021","journal-title":"J Exp Orthop"},{"key":"2026010204251099000_18.12.e268853.2","first-page":"195","article-title":"Pretibial cyst formation after anterior cruciate ligament reconstruction: a systematic review of the literature","volume":"18","author":"Perrone","year":"2017","journal-title":"J Orthop Traumatol"},{"key":"2026010204251099000_18.12.e268853.3","unstructured":"Travascio F . Tunnel widening of ACL reconstruction augmented by an osteoconductive-osteoinductive allograft compound with platelet rich plasma: a randomized blind-analysis pilot study. medRxiv 2022."},{"key":"2026010204251099000_18.12.e268853.4","first-page":"2649","article-title":"Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up","volume":"49","author":"Hagmeijer","year":"2021","journal-title":"Am J Sports Med"},{"key":"2026010204251099000_18.12.e268853.5","first-page":"1209","article-title":"The risk of new meniscal tears after anterior cruciate ligament reconstruction is higher in patients with delayed surgery","volume":"23","author":"Papastergiou","year":"2007","journal-title":"Arthroscopy"},{"key":"2026010204251099000_18.12.e268853.6","doi-asserted-by":"crossref","unstructured":"Gupta A , Badin D , Ortiz-Babilonia C , et al . Is Delayed Anterior Cruciate Ligament Reconstruction Associated With a Risk of New Meniscal Tears? Reevaluating a Longstanding Paradigm. Orthop J Sports Med 2023;11. doi:10.1177\/23259671231203239","DOI":"10.1177\/23259671231203239"},{"key":"2026010204251099000_18.12.e268853.7","first-page":"e1069","article-title":"Two-Stage Revision Anterior Cruciate Ligament Reconstruction","volume":"5","author":"Mitchell","year":"2016","journal-title":"Arthrosc Tech"},{"key":"2026010204251099000_18.12.e268853.8","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.arthro.2005.12.039","article-title":"A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction","volume":"22","author":"Said","year":"2006","journal-title":"Arthroscopy"},{"key":"2026010204251099000_18.12.e268853.9","doi-asserted-by":"crossref","unstructured":"Franceschi F , Papalia R , Del Buono A , et al . Recurrent pretibial cyst formation after anterior cruciate ligament reconstruction. 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