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

Abstract

ObjectivesThe primary aim was to evaluate risk factors for surgical site infections after anterior cruciate ligament reconstruction (ACLR). The secondary aim was to investigate the surgical site infection incidence rate and the mean time to postoperative surgical site infection symptoms.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase and Web of Science were searched from database inception to September 2021 and updated in April 2022.Eligibility criteriaQuantitative, original studies reporting potential risk factors for surgical site infections after ACLR were included.ResultsTwenty-three studies with 3871 infection events from 469 441 ACLRs met the inclusion criteria. Male sex (OR 1.78, p< 0.00001), obesity (OR 1.82, p=0.0005), tobacco use (OR 1.37, p=0.01), diabetes mellitus (OR 3.40, p=0.002), steroid use history (OR 4.80, p<0.00001), previous knee surgery history (OR 3.63, p=0.02), professional athlete (OR 4.56, p=0.02), revision surgery (OR 2.05, p=0.04), hamstring autografts (OR 2.83, p<0.00001), concomitant lateral extra-articular tenodesis (OR 3.92, p=0.0001) and a long operating time (weighted mean difference 8.12, p=0.005) were identified as factors that increased the risk of surgical site infections (superficial and deep) after ACLR. Age, outpatient or inpatient surgery, bone-patellar tendon-bone autografts or allografts and a concomitant meniscus suture did not increase the risk of surgical site infections. The incidence of surgical site infections after ACLR was approximately 1% (95% CI 0.7% to 1.2%). The mean time from surgery to the onset of surgical site infection symptoms was approximately 17.1 days (95% CI 13.2 to 21.0 days).ConclusionMale sex, obesity, tobacco use, diabetes mellitus, steroid use history, previous knee surgery history, professional athletes, revision surgery, hamstring autografts, concomitant lateral extra-articular tenodesis and a long operation time may increase the risk of surgical site infections after ACLR. Although the risk of surgical site infections after ACLR is low, raising awareness and implementing effective preventions for risk factors are priorities for clinicians to reduce the incidence of surgical site infections due to its seriousness.

Deep Infection After Anterior Cruciate Ligament Reconstruction Diagnosed by Intratunnel Suspensory Fixation Device Migration

“…A history of superficial infection at 2 weeks postoperatively along with the increased inflammatory markers, swelling, and the MRI findings suspicious of a pericondylar abscess led to a diagnosis of deep infection. Although a higher risk of SSI has been observed in the hamstring tendon grafts than in bone-patellar tendon-bone grafts 1,2 , deep infection was not initially suspected in this case because infection at the femoral side after ACL reconstruction is rare 16 . To the best of our knowledge, there have been no reports on tunnel widening and implant intratunnel migration because of deep infection.…”

“…Previous studies have reported several risk factors of infection after ACL reconstruction 2,16 . One thing to note is that atopic dermatitis may be a risk factor because patients are susceptible to S. aureus colonization 22,23 .…”

“…nfection after anterior cruciate ligament (ACL) reconstruction is rare and has been reported in approximately 1% of surgeries 1,2 . Early diagnosis of infection based on clinical symptoms, laboratory and radiographic findings, and immediate treatment is critical because delay in treatment can lead to graft failure, articular cartilage damage, and further joint dysfunction [3][4][5] .…”

Patellar Tendon Reconstruction After Failed Primary Repair of Bilateral Ruptures

“…It was therefore decided to proceed with hematoma evacuation, debridement including removal of all foreign material such as sutures, and lavage. Infection was ruled out before performing a reconstruction procedure using an allograft because elevated infection rates have been reported for tendon reconstructions using allografts or autografts in comparison with tendon repairs [11][12][13] . Various types of reconstruction have been proposed for defects that cannot be approached with primary repair because of defect size, retraction of tendon stumps that precludes adequate reapproximation, or poor tendon quality [14][15][16][17][18] .…”

A meta‐analysis of the risk factors of surgical site infection after hysterectomy for endometrial cancer

“…It has been suggested that initiating intensive glycemic control for 24 h after gynecologic oncology surgery in EC patients with diabetes or postoperative blood sugar significantly lowers the SSI rate 27,28 . It has been determined that increased BMI (≥30 kg/cm 2 ) was identified to be an independent risk factor for SSI when patients undergoing general, orthopaedic and gynaecological surgery 16,24,29–32 . Emerging data have demonstrated a correlation between BMI and the risk of SSI in EC patients 9,33 .…”