The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction

Abstract

Allergy to metal, especially to titanium, is a poorly known subject in orthopedic surgery and is mostly found after arthroplasty. Here, we describe an original case of titanium allergy that developed after an anterior cruciate ligament (ACL) reconstruction of the left knee in a patient with a history of severe atopic dermatitis. Three years after the surgery, he returned to the clinic with the femoral cortical button in his hand; he removed the device from the wound when the skin spontaneously opened at the lateral part of the thigh. The wound healed with dressings without use of any antibiotics. Clinical and functional results were favorable and magnetic resonance imaging signal of the graft was normal. We ruled out the possibility of infection and the final diagnosis was allergy to titanium. This case demonstrates the need to investigate the presence of allergy to metal, including titanium, before an ACL reconstruction.