Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital

Abstract

Background Septic arthritis (SA) of the knee following anterior cruciate ligament reconstruction (ACLR) is considered a catastrophic complication in terms of reduced or loss function of the involved joint. The aims of this study were to gauge the incidence, risk factors, and causative organisms of SA after ACLR. Methods We conducted a retrospective review of 836 patients who underwent primary ACLR at our institution from October 2018 to September 2021. Patients’ demographics, onset of presentation, clinical symptoms, laboratory findings, and management details were obtained from patients’ electronic medical records. Results Out of the 836 primary ACLRs, 12 were complicated with SA (1.43%). Independent risk factors associated with SA included age (OR; 11.12, 95% CI; 1.3–94.97), obesity (OR; 8.51, 95% CI; 1.02–71.13), and diabetes mellitus (OR; 12.58, 95% CI; 2.39–66.3). Staphylococcus aureus was the most frequent culprit organism (66.7%), followed by Streptococcus species (25%), and Pseudomonas aeruginosa (8.3%). No fungal, mycobacterial, or polymicrobial growth were recovered from synovial fluid cultures. All of the infected cases underwent arthroscopic joint lavage and debridement in the operating room followed by intravenous antibiotics. Graft removal was not done in any of the involved patients, with eradication of infection in all cases. Conclusion SA after ACLR is uncommon, with S. aureus identified in about two-thirds of the patients. Prompt diagnosis and treatment are crucial to avoid graft loss and arthritis-associated joint damage. Orthopedic surgeons should consider rigorous implementation of infection control strategies to minimize the incidence of this devastating morbidity.

Management of ACL Reconstruction Complicated by MRSA Osteomyelitis Requiring a Gastrocnemius Perforator Flap

“…Numerous studies have shown positive outcomes with graft retention in the setting of post-ACL-R infection, in which the graft appears healthy during the first I&D 18,19 . However, all patients with successfully retained grafts reported no continuing signs of infections after initial debridement and intravenous antibiotics 18,19 . In cases when the infection continues and further debridement is necessary, 1 treatment algorithm from Geethan et al identified that graft removal becomes a priority.…”

“…On initial presentation, hardware removal was our foremost consideration. Numerous studies have shown positive outcomes with graft retention in the setting of post-ACL-R infection, in which the graft appears healthy during the first I&D 18,19 . However, all patients with successfully retained grafts reported no continuing signs of infections after initial debridement and intravenous antibiotics 18,19 .…”

Diabetes in Orthopaedic Sports Medicine Surgeries Standard Review

“…Other studies exist that suggest DM is not a risk factor for infection after ACLR, although these may reflect a lack of power rather than robust findings. Multiple national database studies have found no increased infection risk because of DM within 30 days postoperatively 12,13 ; although one of the studies reported an infection rate of 5.1% in patients with DM undergoing ACLR compared with 1.7% in patients without DM, the P -value was 0.14 22 . Similarly, a study out of India reported an OR for developing an infection after ACLR in patients with DM of 4.8, but the P -value was 0.16 14 .…”

“…Using the MOON database to identify a cohort of 2,291 patients who underwent Bankart repair for labral injuries, DeFroda et al 20 found that DM increased risk for readmission (OR = 2.70). Manzi et al 13 identified DM as a risk factor for readmission within 30 days after ACLR (OR = 2.14) in a large database study of 9,576 patients. Finally, Christian et al 21 conducted a retrospective case-control study within 5,598 patients who underwent shoulder arthroscopy and found DM increased risk of readmission (OR = 2.11).…”