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Musculoskeletal and Sports Medicine

Fungal infection following anterior cruciate ligament reconstruction in a young female soccer player: a case report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 3

    Primary Author(s)

  • Kyle Kinder, MD

    Resident Physician
    UCLA David Geffen SOM/ UCLA Medical Center/VA Greater Los Angeles Health
    Los Angeles, California

    • Co-Author(s)

  • KD

    Kevin A. Diaz, MD

    Sports medicine physician
    Los Angeles County-Harbor- UCLA Medical Center Sports Medicine Fellowship
    Sacramento, California

Disclosure(s):
Kyle Kinder, MD: No financial relationships to disclose
Case Diagnosis: An 18 year old female soccer player with a history of anterior cruciate ligament (ACL) reconstruction develops chronic left knee pain two years later and is found to have a fungal infection at her graft site.

Case Description or Program Description: The patient underwent ACL reconstruction (ACLR) in 2020. Two years later she presented to her college's sports medicine clinic after landing "awkwardly" on her left knee in practice. She showed no signs or symptoms of infection or knee instability to prompt advanced imaging or aspiration. Her symptoms partially improved with conservative measures but over the course of several weeks she developed mechanical symptoms and instability.

Setting: Collegiate sports medicine clinic.

Assessment/Results: Magnetic resonance imaging demonstrated bone resorption in the tibial and femoral tunnels and a hyperintese fluid collection at the distal femur at the site of the EndoButton. The graft was then cultured and grew aspergillus. She subsequently underwent ACL graft removal and antibiotic treatment followed by bone grafting to the tibial and femoral tunnels and ACL reconstruction with patellar autograft.

Discussion (relevance): Fungal infection is a rare post-operative complication following ACLR. These infections pose a diagnostic challenge as they typically present in an occult fashion. Fungal infections following ACLR can result in significant joint destruction leading to prolonged treatment courses and deficits in rehab potential. The incidence of fungal infections following ACLR is not well-documented. There exists a paucity of case reports and a small case series to provide insight into the clinical presentation and management of this disease.

Conclusions: The case we present, as well as others like it, demonstrate the smoldering nature of and diagnostic challenge to fungal infections following ACLR, emphasizing the importance of maintaining high clinical suspicion in patients who have recently (or not-so-recently) undergone ACLR as well as prompt treatment to prevent potentially catastrophic outcomes.