ESSKA and EBJIS recommendations for the management of infections after anterior cruciate ligament reconstruction (ACL‐R): prevention, surgical treatment and rehabilitation

Abstract

Purpose Infection after anterior cruciate ligament reconstruction (ACL-R) is a rare but severe complication. Despite an increase in articles published on this topic over the last decade, solid data to optimized diagnostic and therapeutic measures are scarce. For this reason, the European Bone and Joint Infection Society (EBJIS) and the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) collaborated in order to develop recommendations for the diagnosis and management of infections after ACL-R. The aim of the workgroup was to perform a review of the literature and provide practical guidance to healthcare professionals involved in the management of infections after ACL-R. Methods An international workgroup was recruited to provide recommendations for predefined clinical dilemmas regarding the management of infections after ACL-R. MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for evidence to support the recommended answers to each dilemma. Results The recommendations were divided into two articles. The first covers etiology, prevention, diagnosis and antimicrobial treatment of septic arthritis following ACL-R and is primarily aimed at infectious disease specialists. This article includes the second part of the recommendations and covers prevention of infections after ACL-R, surgical treatment of septic arthritis following ACL-R and subsequent postoperative rehabilitation. It is aimed not only at orthopedic surgeons, but at all healthcare professionals dealing with patients suffering from infections after ACL-R. Conclusion These recommendations guide clinicians in achieving timely and accurate diagnosis as well as providing optimal management, both of which are paramount to prevent loss of function and other devastating sequelae of infection in the knee joint. Level of evidence V.

Poorer patient‐reported outcome and increased risk of revision at a 5‐year follow‐up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register‐based cohort study of 23,075 primary anterior cruciate ligament reconstructions

“…Septic arthritis following anterior cruciate ligament reconstruction (ACLR) is a rare yet severe adverse event. It often requires multiple surgical interventions and long-term treatment with antibiotics and may lead to joint damage and permanent disability [23,35]. In the literature, the incidence of septic arthritis following ACLR is reported as being between 0.28 and 1.1%, with identiied risk factors such as male sex, longer operating time, graft choice and choice of perioperative antibiotic prophylaxis [3,4,14,22].…”