Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes

Abstract

The prevalence of septic arthritis after an ACL reconstruction in this series was 1.8 %. Arthroscopic lavages along with antibiotic treatment led us to preserve all but one graft. Functional outcomes in the infected patients were not as good as those obtained in patients without infection.

Mini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report

“…Elevated acute phase reactants, determination of bacteria in the gram stain of the sample taken from the joint, or increased levels of polymorphonuclear leukocytes may help the diagnosis. The culture of the sample obtained from the joint fluid by puncture is necessary to identify the pathogen in the diagnosis of septic arthritis and to determine which antibiotics to administer [1,19]. The absence of bacterial proliferation in the sample obtained from the joint fluid does not exclude a diagnosis of septic arthritis.…”

Managing septic arthritis after knee ligament reconstruction

“…The lowest rate was presented by Indelli et al [2], who reported a rate of 0.14 % for septic arthritis in a series of 3500 consecutive ACLR patients. On the other hand, the highest published rates are by Torres-Claramunt et al [3] (1.8 % in a series with 810 consecutive ACLR) and Shollin-Borg et al [4] (1.7 % in a series with 575 ACLR). Viola et al [5] reported a retrospective series with 13 patients diagnosed with septic arthritis following ACLR performed with a bone-patellar tendonbone (BPTB) autograft.…”

“…aureus and CNS (S. epidermidis and other coagulasenegative species) are the most common bacteria found in most series [2,3,5,7,10,11,[14][15][16]. Additionally, different methicillin-resistant S. aureus or anaerobium microorganisms have also been cultured as the origin of such infections.…”

“…Additionally, different methicillin-resistant S. aureus or anaerobium microorganisms have also been cultured as the origin of such infections. This fact should be considered when empirical antibiotic treatment is initiated [3,14]. Staphylococcus is a microorganism capable of forming a biofilm within the first few weeks that protects itself from antimicrobials, thus making it difficult to eradicate [17].…”

“…Arthroscopy must include extensive lavage with normal serum, debridement of devitalised tissue, removal of fibrin clots and synovectomy. It is also suggested to remove the fibrin layer covering the graft surface [3] and evaluate the macroscopic integrity of the graft as well as its tension. If the graft is not viable, it should be removed, along with fixation hardware.…”