Infections in Anterior Cruciate Ligament Reconstruction

Abstract

Context:Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome.Evidence Acquisition:Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters.Results:Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates.Conclusion:The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis.

Delayed onset bioabsorbable screw reaction, intact screw extrusion andPseudomonas aeruginosatibial tunnel osteomyelitis years after arthroscopic anterior cruciate ligament reconstruction using hamstring graft

“…As mentioned, the risk of postoperative infection in patients undergoing ACL reconstruction is relatively low at 0.5% for the combined incidence for acute (<2 weeks), subacute (from 2 weeks to 2 months) and late (>2 months) 4. Local symptoms such as surgical site pain, inflammation and effusion as consistent with our patients have been described as more constant than constitutional symptoms such as fever and chills 4.…”

“…Arthroscopic ACL reconstructions have very low hardware-related complications and infection rate (from 0.001% to 1.100%), with Staphylococcus sp. as the most common pathogen 4 5. Revisions are performed in less than 5% of cases.…”

Hybrid Graft Anterior Cruciate Ligament Reconstruction: A Predictable Graft for Knee Stabilization

“…15 Using a traditional autograft may also result in a long-term reduction in the strength and speed of the hamstring muscles at high flexion angles. 3,14 In many patients, graft harvest does not result in a clinical disability or diminished sport performance; however, the ability to maintain fully functional hamstrings may benefit certain patients. A hybrid graft allows the surgeon to customize the size of the graft for reconstruction by augmenting autograft hamstring with soft tissue allograft.…”

“…For an active patient, surgical stabilization is recommended to return the athlete back to his or her sport. [1][2][3] In the United States, the annual incidence of ACL tears is approximately 200,000. 4 Although surgical techniques and implants vary and autograft patellar tendon has historically been considered the gold standard for graft selection, soft tissue ACL reconstruction has become increasingly popular.…”

“…The main limitations of the traditional autograft may result in a longterm reduction in the strength and speed of the hamstring muscles at high flexion angles. 3,14 In both planned primary ACL reconstruction or revision surgery and in alternative backup reconstruction when autologous tissue is inadequate or damaged during harvest, hybrid soft tissue provides a reliable and predictable ACL graft and should be considered when counseling patients for surgery.…”