Incidence, Risk Factors, and Management of Infection Following Anterior Cruciate Ligament Reconstruction Surgery

Abstract

Background:Infection after anterior cruciate ligament reconstruction surgery (ACLRS) is a rare complication. Although there are number of studies from various Caucasian population but only few studies are available from Asian population. The aim of the study is to assess the incidence, risk factors and, clinical outcome using our treatment protocol.Materials and Methods:Out of 1468 arthroscopic ACLRS, 26 patients with clinical suspicion of infection were critically analysed in terms of laboratory reports of arthrocentesis, erythrocyte sedimentation rate, C-reactive protein and risk factors such as the type of graft, gender, diabetes mellitus, smoking, intraarticular steroid injection, and obesity. At final followup, all these patients were evaluated using visual analog scale (VAS), Lysholm knee score, and Tegner activity level.Results:In nine patients, culture did not show any growth and they showed improvement with arthrocentesis and oral antibiotics. These patients were labeled as suffering from aseptic effusion. In the remaining 17 patients, there was no clinical improvement or instead worsening of symptoms after arthrocentesis and oral antibiotics. These patients were labeled as suffering from an infection and underwent surgical debridement along with administration of injectable antibiotics. The history of intraarticular steroid injection before ACLRS was a significant risk factor for developing infection (P = 0.001). At mean followup of 2.8 years, mean VAS improved to 1.18 ± 0.99 from 6.2 ± 2.3. The mean Lysholm knee score and Tegner's activity level at the final followup were 79.2 ± 10.52 and 4.8 ± 2.30, respectively.Conclusion:The incidence of infection was 1.2% (17/1468). The step-ladder approach of differentiating between aseptic effusion and infection and accordingly, following a treatment protocol, i.e., oral antibiotics alone or surgical debridement along with injectable antibiotics or additional debridement of graft in refractory patients, yielded satisfactory results.

Improved cytocompatibility and antibacterial properties of zinc-substituted brushite bone cement based on β-tricalcium phosphate

“…Indeed, postsurgical infection after osteosynthesis has an incidence of 0.5–10% for closed fracture [ 54 ] and up to 50% for open fractures [ 55 ]. It occurs in 1–14% of patients after spine surgery [ 56 ] and has similar incidence for several orthopedic and trauma procedures involving implantable devices [ 57 ]. The socioeconomic burden and management of such infections are incredibly challenging.…”

Risk factors for postoperative surgical site infections after anterior cruciate ligament reconstruction: a systematic review and meta-analysis

“…The pooled analysis showed that the mean time from surgery to the onset of surgical site infection symptoms was 17.1 days (95% CI, 13.2 to 21.0 days; I 2 =77%) ( online supplemental A5 ). The sensitivity analysis found that Gupta et al 25 was the main source of the heterogeneity, and the I 2 was reduced to 38% after the study was removed. A pooled analysis of the remaining studies showed that the mean time from surgery to the onset of surgical site infection symptoms was 18.4 days (95% CI, 15.2 to 21.6 days).…”

“…It is speculated that the main source of the heterogeneity was the difference in the study population. Gupta et al 25 is the only study from an Asian population (India), while the remaining studies are from European and US populations.…”

Antibacterial coating of implants: are we missing something?

“…13 Post-surgical infection following spine surgery occurs in 1% to 14% of patients, depending on the preoperative diagnosis and type of surgery; 14,15 similar figures are reported for a variety of surgical procedures involving implantable devices in orthopaedics and trauma. 16-18…”