Infection After Arthroscopic Anterior Cruciate Ligament Reconstruction

Abstract

Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4-218 months). An average of 1.92 procedures (range, 1-5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5-90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23-100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment.

A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

“…Several reviews have reported the incidence of septic arthritis after ACL reconstruction to range from 0.5% to 0.6%. 95 , 187 , 219 Surgical irrigation and debridement combined with antibiotic therapy was the recommended treatment as opposed to antibiotics alone, which may lead to more failures. 95 , 219 The mean number of debridements ranged from 1.52 to 1.92, with 34% to 40% of patients needing more than 1 debridement.…”

“… 95 , 187 , 219 Surgical irrigation and debridement combined with antibiotic therapy was the recommended treatment as opposed to antibiotics alone, which may lead to more failures. 95 , 219 The mean number of debridements ranged from 1.52 to 1.92, with 34% to 40% of patients needing more than 1 debridement. 95 , 187 , 219 Graft retention rates ranged from 77% to 85%, and failures were increased for allografts versus autografts.…”

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

“…[19][20][21] The length of antibiotic therapy is controversial and ranges from 5 to 90 days. 7,19 With 6 weeks of antibiotic treatment, we chose a relatively long administration period. Recently, approaches for a more individualized duration of antibiotic treatment based on CRP level were made, revealing a mean treatment period of 5.4 AE 2.3 weeks, 16 which is very close to our interval.…”

“…The length of antibiotic therapy ranges from 5 to 90 days, and depending on clinical findings and biomarker levels, repeated irrigations after 48 to 72 hours are considered. 2,7 Occasionally, a graft removal is necessary, which increases the treatment duration and may lead to further reconstructive procedures and impaired functional outcome. 1 We hypothesized that effective infection therapy and reliable graft preservation is possible following a standard protocol consisting of at least three arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks.…”

Clinical efficacy of multiple prevention measures against infection following anterior cruciate ligament reconstruction

“…A knee infection usually results in difficult wound healing, a limited range of knee motion, articular cartilage damage, and even traumatic arthritis. Moreover, some patients may need to undergo second or multiple operations to remove the graft and the internal fixation devices [8] . Therefore, measures to prevent postoperative infections after ACL reconstructions are urgently needed.…”