Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

Abstract

Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ± 9.9) years and admitted 14 ( ± 7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

Deep Infection After Anterior Cruciate Ligament Reconstruction Diagnosed by Intratunnel Suspensory Fixation Device Migration

“…because it cannot be clarified whether tendon-bone integration is sufficient. In this case, although MRI showed high signal intensity inside the femoral bone tunnel, graft-preserving treatment was attempted first; as per the protocol proposed by previous reports, the condition was identified as early as 3 months postoperatively [6][7][8] . Despite removal of the fixation hardware, this patient's graft remained well-fixed, suggesting femoral-sided graft integration by 15 weeks.…”

“…Early diagnosis of infection based on clinical symptoms, laboratory and radiographic findings, and immediate treatment is critical because delay in treatment can lead to graft failure, articular cartilage damage, and further joint dysfunction [3][4][5] . Arthroscopic debridement with graft preservation has been advocated as a treatment of infection after ACL reconstruction [6][7][8] , but it is unclear whether the graft can be preserved or whether early removal of fixation devices affects graft integration and knee stability. We report a rare case of femoral suspensory fixation site deep infection after ACL reconstruction in the early postoperative period.…”

Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital

“…The majority of our recruited patients reported symptoms/signs of arthritis within 6–47 days’ post-operative, which agrees with the existing literature, suggesting incidence of most of the episodes within 2 months postoperative. 22 Previous literature showed that the incidence of SA following ACLR ranged from 0.14% to 2.6%. 11 A systematic analysis by Makhni and associates identified 169 infections out of 31,750 patients accounting for 0.53% infection rate.…”

Inadvertent Debridement of the Medial Patellofemoral Ligament Following Arthroscopic Knee Surgery for Infection: A Case Report

“…Hantes et al obtained good to excellent outcomes following a similar approach in the management of their cases [ 8 ]. Most of the authors prefer to retain the graft in case of septic arthritis following ACLR [ 2 , 9 ]. A recent literature review shows that 43.8% of the patients who underwent graft removal required a secondary ACLR, but only 6.5% of patients with graft retention required this second surgery [ 2 ].…”