Analysis of Acute Intra-articular Infections after Arthroscopic Knee Ligament Reconstruction: 15 years results
Author(s):
Kameda T. (Japan)
Kameda T. (Japan)
Affiliations:
ESSKA Academy. Kameda T. 05/09/18; 209796; P17-191 Topic: Arthroscopic Surgery
Toshiaki Kameda
Toshiaki Kameda
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Abstract
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Objectives: Acute septic arthritis after arthroscopic knee ligament reconstruction is rare and may result in severe morbidity and poor clinical outcome. The purpose of this study was to retrospectively clarify acute septic arthritis after arthroscopic knee ligament reconstruction in a single hospital.

Methods: 473 patients (489 knees) who underwent knee ligament reconstruction in our university hospital were enrolled in this study between 2001 and 2015. There were 318 men and 155 women with a mean age of 28 years (12-62 years) at the time of surgery. In surgical procedure, 376 knees underwent ACL reconstruction, 12 knees underwent posterior cruciate ligament reconstruction. 44 knees underwent revision ACL reconstruction. 57 knees underwent multiple ligament reconstruction. All patients had received intravenous first-generation cephalosporin just before surgery and for 3 days after the procedure. A pneumatic tourniquet was used for all procedure. The mean follow-up period was 28 months (12-56 months). The operation time, characteristics and clinical outcomes were evaluated. Statistical comparison was made using the paired Student t test. The significance level was set at p=0.05.

Results: Five of 489 (1.0%) knees developed acute postoperative septic arthritis. Each one patient underwent primary or revision ACL reconstruction. 3 patients underwent multiple ligament reconstruction. All patients were men with a mean age of 28 years (20-37 years). The operation time averaged 198 minutes and the tourniquet time averaged 179 minutes for these 5 cases. All patients were smoker but didn't have any medical history. Hamstring, biceps tendon, and quadriceps tendon were used for grafts. The infection rate of multiple ligament reconstruction (5.3%) was significantly higher compared with the rate of ACL reconstruction (0.3%, p=0.0002). 4 of 5 cases had a fever over 38 degrees Celsius within 2 weeks after surgery. Cultures were positive for methicillin-resistant Staphylococci in 4 of 5 cases. All cases underwent arthroscopic synovectomy at a mean of 16 days after the procedure and followed a continuous closed irrigation for 2 weeks. The infection could be controlled without the graft removal. Postoperatively, no patients had loss of knee extension (>5 degrees), and 4 patients had loss of flexion (>10 degrees). The mean Lysholm knee scoring scale was 96 (5) points. Concerning the International Knee Documentation Committee evaluation, 1 and 4 cases was graded as B and C. Kellgren and Lawrence grade progressed from 0 to 2 in 2 of 5 cases and from 2 to 3 in 1 case.

Conclusions: The infection rate of knee ligament reconstruction was 1.0% in our hospital. The rate of multiple ligament reconstruction (5.3%) was significantly higher compared with the rate of ACL reconstruction (0.3%). All cases underwent arthroscopic synovectomy within 3 weeks after the procedure and followed a continuous closed irrigation for 2 weeks. The infection could be controlled without the graft removal.

Keywords:
Knee ligament reconstruction, septic arthritis
Objectives: Acute septic arthritis after arthroscopic knee ligament reconstruction is rare and may result in severe morbidity and poor clinical outcome. The purpose of this study was to retrospectively clarify acute septic arthritis after arthroscopic knee ligament reconstruction in a single hospital.

Methods: 473 patients (489 knees) who underwent knee ligament reconstruction in our university hospital were enrolled in this study between 2001 and 2015. There were 318 men and 155 women with a mean age of 28 years (12-62 years) at the time of surgery. In surgical procedure, 376 knees underwent ACL reconstruction, 12 knees underwent posterior cruciate ligament reconstruction. 44 knees underwent revision ACL reconstruction. 57 knees underwent multiple ligament reconstruction. All patients had received intravenous first-generation cephalosporin just before surgery and for 3 days after the procedure. A pneumatic tourniquet was used for all procedure. The mean follow-up period was 28 months (12-56 months). The operation time, characteristics and clinical outcomes were evaluated. Statistical comparison was made using the paired Student t test. The significance level was set at p=0.05.

Results: Five of 489 (1.0%) knees developed acute postoperative septic arthritis. Each one patient underwent primary or revision ACL reconstruction. 3 patients underwent multiple ligament reconstruction. All patients were men with a mean age of 28 years (20-37 years). The operation time averaged 198 minutes and the tourniquet time averaged 179 minutes for these 5 cases. All patients were smoker but didn't have any medical history. Hamstring, biceps tendon, and quadriceps tendon were used for grafts. The infection rate of multiple ligament reconstruction (5.3%) was significantly higher compared with the rate of ACL reconstruction (0.3%, p=0.0002). 4 of 5 cases had a fever over 38 degrees Celsius within 2 weeks after surgery. Cultures were positive for methicillin-resistant Staphylococci in 4 of 5 cases. All cases underwent arthroscopic synovectomy at a mean of 16 days after the procedure and followed a continuous closed irrigation for 2 weeks. The infection could be controlled without the graft removal. Postoperatively, no patients had loss of knee extension (>5 degrees), and 4 patients had loss of flexion (>10 degrees). The mean Lysholm knee scoring scale was 96 (5) points. Concerning the International Knee Documentation Committee evaluation, 1 and 4 cases was graded as B and C. Kellgren and Lawrence grade progressed from 0 to 2 in 2 of 5 cases and from 2 to 3 in 1 case.

Conclusions: The infection rate of knee ligament reconstruction was 1.0% in our hospital. The rate of multiple ligament reconstruction (5.3%) was significantly higher compared with the rate of ACL reconstruction (0.3%). All cases underwent arthroscopic synovectomy within 3 weeks after the procedure and followed a continuous closed irrigation for 2 weeks. The infection could be controlled without the graft removal.

Keywords:
Knee ligament reconstruction, septic arthritis
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