Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: Retrospective case review

Erice, Alejo; Neira, Manuel; Vargas-Prada, Sergio; Chiaraviglio, Ana; Gutiérrez-Guisado, Javier; Oya, Ricardo Rodríguez de

doi:10.1016/j.eimce.2018.04.005

Cited by 7 publications

(11 citation statements)

References 15 publications

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“… 40 Amongst the 12 performed arthrocenteses in our study, synovial leucocytic counts (as summarized in Table 4 ) demonstrated marked elevation compared to previous authors. 15 Notably, a previous observational study, which included 24 infected and 14 uninfected patients, underlined that at a cutoff value of 40,000 WBCs/mL; diagnosis of postoperative SA could be achieved with 100% specificity. 41 …”

Section: Discussionmentioning

confidence: 97%

“…Previous data indicate that Staphylococcus species are the most commonly encountered organisms, with coagulase-negative staphylococci (CoNS) involved in 43% of the episodes followed by Staphylococcus aureus . 15 On the flip side, mycotic infections complicating ACLR are extremely rare with 14 cases had been documented so far. They are associated with worse functional outcomes in comparison to Staphylococcal arthritis.…”

Section: Introductionmentioning

confidence: 99%

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

El-Kady¹,

Elguindy²

2022

IDR

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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.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

El-Kady¹,

Elguindy²

2022

IDR

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“…Recently, another study that analyzed 30 patients with septic arthritis after ACL reconstruction was published and reported a 100% cure rate with arthroscopic debridement and an individualized antibiotic therapy, which led to a broad range of treatment duration (14-78 days; median: 23.5 days). 18 Staphylococcus aureus was isolated in 12 (40%) and gram-negative bacilli in 2 (7%) patients. Nevertheless, results after I&D and antibiotic therapy are highly variable, as pointed out by a systematic review that included 11 case series.…”

Section: Discussionmentioning

confidence: 99%

“…These findings are generally in line with other publications, although the proportion of S. aureus differs between the cohorts. 1,[16][17][18] The prevalence of COSTs was 65%, entailing methicillin resistance in 77% of those cases. Less frequently, gram-negative bacteria were detected in 10% of our patient population.…”

Section: Discussionmentioning

confidence: 99%

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

Otchwemah

Naendrup

Mattner³

et al. 2018

J Knee Surg

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Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ± 9.9) years and admitted 14 ( ± 7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

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“…Our data show for the first time that in arthroscopic knee surgery irrigation fluid reservoirs on surgical covers are prone to increasing bacterial contamination over time. Furthermore, as postoperative knee infection is attributed to a multitude of different microorganisms, which are predominantly part of the physiological skin flora [ 12 , 22 ], bacterial contamination of irrigation fluid and suture and fixation material first investigated in this study may not necessarily imply, but could be the potential source of surgical site infection.…”

Section: Discussionmentioning

confidence: 99%

Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery

Bartek¹,

Winkler

Garbe³

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose During knee arthroscopy, irrigation fluid from the surgical site accumulates in the sterile reservoir. Whether these fluid collections and also suture material used during the arthroscopic surgical processes show bacterial contamination over time during surgery remains unclear. The purpose of this study was to determine this contamination rate and to analyze its possible influence on postoperative infection. Materials and methods In this study, 155 patients were included. Fifty-eight underwent reconstruction of the anterior cruciate ligament (ACL), 63 meniscal surgery and 34 patients combined ACL reconstruction and meniscus repair. We collected pooled samples of irrigation fluid from the reservoir on the sterile drape every 15 min during the surgery. In addition, we evaluated suture material of ACL graft and meniscus repair for bacterial contamination. Samples were sent for microbiological analysis, incubation time was 14 days. All patients were seen in the outpatient department 6, 12 weeks and 12 months postoperatively and examined for clinical signs of infection. Results A strong statistical correlation (R2 = 0.81, p = 0.015) was found between an advanced duration of surgery and the number of positive microbiological findings in the accumulated fluid. Suture and fixation material showed a contamination rate of 28.4% (29 cases). Despite the high contamination rate, only one infection was found in the follow-up examinations, caused by Staphylococcus lugdunensis. Conclusion Since bacterial contamination of accumulated fluid increases over time the contact with the fluid reservoirs should be avoided. Level of evidence IV.

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Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: Retrospective case review

Cited by 7 publications

References 15 publications

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

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

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

Bacterial contamination of irrigation fluid and suture material during ACL reconstruction and meniscus surgery

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