Septic arthritis following an arthroscopic anterior cruciate ligament (ACL) reconstruction: a retrospective analysis of incidence, management and outcome
Author(s):
Nabergoj M. (Slovenia)
,
Nabergoj M. (Slovenia)
Affiliations:
Ambrozic B.
,
Ambrozic B.
Affiliations:
Novak S.
Novak S.
Affiliations:
ESSKA Academy. Nabergoj M. 05/09/18; 209422; P05-1821 Topic: Arthroscopic Surgery
Mr. Marko Nabergoj
Mr. Marko Nabergoj
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Abstract
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Objectives: Septic arthritis of the knee is a rare but serious complication after arthroscopic ACL reconstruction. The aim of this study was to determine the incidence and management of knee joint infection after arthroscopic ACL reconstruction and to assess the clinical outcome.

Methods: A retrospective analysis of knee joint infections occurring after 1,472 arthroscopically assisted anterior cruciate ligament reconstructions between 1.1.2008 and 31.12.2016 was conducted. Patients with signs and symptoms of joint infection along with blood laboratory parameters suggestive of infection were considered as septic arthritis. 8 patients (0.5%), 1 female and 7 males, were treated for postoperative septic arthritis of the knee after ACL reconstruction. Two were acute, four subacute and two chronic. All of them underwent urgent arthroscopic intervention, microbiological analysis and intravenous antibiotic treatment.

Results: The mean time from ACL reconstruction to symptoms was 112 days (range, 6 - 590 days). Time from onset of symptoms to arthroscopy was 3.5 days (range, 1 - 6 days), three patients were operated on the same day of admission, two on the second day and three on the third day. At the time of arthroscopic intervention all cases were graded as Gächter stage I or II. The median C-reactive protein level on admission was 56.8 mg/l (range, 11.8 - 141 mg/l) and at arthroscopy 67.6 mg/l (range, 10 - 141 mg/l). Seven patients had only one arthroscopy while the remaining one had two arthroscopies. In all cases the specimens for microbiological analysis were taken, 5 cases were positive for S. Epidermidis and 3 were sterile. In all 5 patients in which histologic examination was performed septic arthritis was confirmed. An average follow-up of the patients was 31 months (range, 15 - 58 months) and in all cases the infect was treated successfully. We retained all the grafts, in 7 cases (87.5%) the results were the same as in non-complicated ACL reconstruction and in one case (12.5%) arthrofibrosis and grade 2 cartilage damage after 3 years after infection were found.

Conclusions: Through fast admission of the patients (right communication between patient and surgeon), urgent arthroscopy and prompt treatment, the infection can be successfully eradicated, with no influence on the final result.

Keywords:
septic arthritis, articular infection, anterior cruciate ligament, knee
Objectives: Septic arthritis of the knee is a rare but serious complication after arthroscopic ACL reconstruction. The aim of this study was to determine the incidence and management of knee joint infection after arthroscopic ACL reconstruction and to assess the clinical outcome.

Methods: A retrospective analysis of knee joint infections occurring after 1,472 arthroscopically assisted anterior cruciate ligament reconstructions between 1.1.2008 and 31.12.2016 was conducted. Patients with signs and symptoms of joint infection along with blood laboratory parameters suggestive of infection were considered as septic arthritis. 8 patients (0.5%), 1 female and 7 males, were treated for postoperative septic arthritis of the knee after ACL reconstruction. Two were acute, four subacute and two chronic. All of them underwent urgent arthroscopic intervention, microbiological analysis and intravenous antibiotic treatment.

Results: The mean time from ACL reconstruction to symptoms was 112 days (range, 6 - 590 days). Time from onset of symptoms to arthroscopy was 3.5 days (range, 1 - 6 days), three patients were operated on the same day of admission, two on the second day and three on the third day. At the time of arthroscopic intervention all cases were graded as Gächter stage I or II. The median C-reactive protein level on admission was 56.8 mg/l (range, 11.8 - 141 mg/l) and at arthroscopy 67.6 mg/l (range, 10 - 141 mg/l). Seven patients had only one arthroscopy while the remaining one had two arthroscopies. In all cases the specimens for microbiological analysis were taken, 5 cases were positive for S. Epidermidis and 3 were sterile. In all 5 patients in which histologic examination was performed septic arthritis was confirmed. An average follow-up of the patients was 31 months (range, 15 - 58 months) and in all cases the infect was treated successfully. We retained all the grafts, in 7 cases (87.5%) the results were the same as in non-complicated ACL reconstruction and in one case (12.5%) arthrofibrosis and grade 2 cartilage damage after 3 years after infection were found.

Conclusions: Through fast admission of the patients (right communication between patient and surgeon), urgent arthroscopy and prompt treatment, the infection can be successfully eradicated, with no influence on the final result.

Keywords:
septic arthritis, articular infection, anterior cruciate ligament, knee
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