A 60-year-old man underwent arthroscopic repair for a supraspinatus tear of his left shoulder. A single 5.5-mm poly-L-lactic acid anchor (Spiralok , DePuy Mitek) was threaded with two strands of #2 (Orthocord ) suture. His medical history does not include rheumatoid arthritis, tuberculosis or previous allergies.
At three-month follow-up, the patient reported a constant low-grade dull left shoulder ache. At nine months, the pain had worsened. He described 'crunching sensation' with shoulder movement. Physical examination revealed a swelling over the anterior aspect of the left shoulder. His range of movements was as follows: external rotation to 50 , elevation to 140 , abduction to 95  and internal rotation to the third lumbar vertebra. Movement was painful and produced crepitus. The visual analogue pain score was 8/10. C-reactive protein, leukocyte and erythrocyte sedimentation levels were normal. Plain radiographs of the shoulder showed no abnormality. A magnetic resonance imaging showed fluid distended subacromial and subdeltoid bursae, containing numerous small bodies of intermediate density on proton density sequences (Figures 1 and 2).  
The patient underwent a left shoulder arthroscopic debridement, evacuation of loose bodies, poly-L-lactic acid anchor and suture removal. Intra-operatively, hundreds of grain-like loose bodies filled the subacromial and subdeltoid bursae. The supraspinatus repair was partially disrupted. No macroscopic evidence of infection could be seen. The poly-L-lactic acid anchor showed no fragmentation. No organisms were grown from operative specimens (early and late cultures).
Microscopically, the loose bodies were found to be inflammatory rice bodies, with an inner amorphous core of acidophilic material, surrounded by a plasma and lymphocytic cell infiltrate, with an outer rim of fibrin-like material. No foreign body granulomas or polymer debris were seen microscopically. Allergen testing using the British Contact Dermatitis Society standard extensive series, as well as patch testing to both anchor and suture material were negative. Post-operatively, the patient's pain improved almost immediately. Two months later, a magnetic resonance imaging scan showed complete resolution of the rice bodies, with mild residual subacromial and subdeltoid bursitis.
The patient regained a full range of shoulder movement but continued to complain of pain and weakness with overhead activity. Six months post-arthroscopic debridement, a revision arthroscopic rotator cuff repair was performed using a 5.5-mm Titanium anchor loaded with suture (Orthocord ). At 12-month follow-up, the patient was pain-free. He remained asymptomatic at two years' post-operation.