Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft

Abstract

Septic arthritis following anterior cruciate ligament reconstruction is an uncommon but a serious complication resulting in six times greater hospital costs than that of uncomplicated ACL surgery and an inferior postoperative activity level. Promptly initiating a specific antibiotic therapy is the most critical treatment, followed by open or arthroscopic joint decompression, debridement and lavage. Staphylococcus lugdunensis is a coagulase-negative staphylococcus predominantly infecting the skin and soft tissue. The few reported cases of bone and joint infections by S. lugdunensis indicate that the clinical manifestations were severe, the diagnosis elusive, and the treatment difficult. If the microbiology laboratory does not use the tube coagulase (long) test to confirm the slide coagulase test result, the organism might be misidentified as Staphylococcus aureus. S. lugdunensis is more virulent than other coagulase-negative staphylococcus; in many clinical situations it behaves like S. aureus, further increasing the confusion and worsening the expected outcome. S. lugdunensis is known to cause infective endocarditis with a worse outcome, septicemia, deep tissue infection, vascular and joint prosthesis infection, osteomyelitis, discitis, breast abscess, urine tract infections, toxic shock and osteitis pubis. We present the first case report in the literature of septic arthritis with S. lugdunensis following arthroscopic ACL revision with bone-patellar-tendon-bone allograft.

From Clinical Microbiology to Infection Pathogenesis: How Daring To Be Different Works forStaphylococcus lugdunensis

“…Another study revealed that during a 40-month period, S. lugdunensis accounted for 1% of the 601 CNS obtained from patients with orthopedic clinical infections, including surgical wounds and infected prostheses (3). Temporal bone osteomyelitis and three cases of S. lugdunensis infective arthritis following surgical procedures have been reported (60,118,132,181).…”

Enhancement of osseointegration of polyethylene terephthalate artificial ligament by coating of silk fibroin and depositing of hydroxyapatite

“…11 Like many polymeric or metallic implants, LARS ligaments can cause serious side effects such as severe synovitis. 12,13 Coating with organic materials of good biocompatibility on artificial graft surface has received increasing interest as an alternative option. In our previous work, hydroxyapatite (HAP) and bioglass coating on PET artificial ligaments could promote the cell compatibility of grafts.…”

Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

“…[19][20][21] There is concern, however, that introducing tissue from deceased human donors may increase the risk of infection. [22][23][24][25][26][27][28][29][30][31][32][33] Studies to date comparing allograft vs autograft tissue for ACL reconstruction have not found statistically significant differences in infection risk but may have been underpowered. [3][4][5]16 Given these concerns, we conducted a study to assess risk factors for infection following ACL reconstruction, with particular attention to the role played by the type of graft implanted.…”