Knee infection following anterior cruciate ligament reconstruction
ESSKA Academy. Ivkovic A. 11/08/19; 284423; epESMA-08 Topic: Sports Related Injuries
Assoc. Prof. Alan Ivkovic
Assoc. Prof. Alan Ivkovic
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Knee infection following anterior cruciate ligament reconstruction

ePoster - epESMA-08

Topic: Sports Trauma

Ivkovic A.1,2,3, Kunovac B.4, Janković S.1,5, Vrgoč G.1
1University Hospital Sveti Duh, Orthopaedic Surgery, Zagreb, Croatia, 2University of Zagreb, School of Medicine, Zagreb, Croatia, 3University of Rijeka, Biotechnology, Rijeka, Croatia, 4St. Catherine's Hospital, Zabok, Croatia, 5University of Zagreb, Faculty of Kinesiology, Zagreb, Croatia

Introduction: Septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction is rare with an overall frequency being reported at 0.14- 2.25% of cases. It is a therapeutic emergency and delaying treatment could lead to graft failure, articular cartilage damage and further joint dysfunction. Different treatment options have been proposed, with surgeons generally agreeing on combination of arthroscopic irrigation and debridement with continuous administration of antibiotics lasting 4-6 weeks
Purpose: This study was undertaken to retrospectively determine the incidence of post-operative knee infection following ACL reconstruction, to identify the most common causative pathogen, to evaluate our treatment approach, as well as to review current recommendations for the management of septic arthritis.
Methods: From January 2007 to December 2017, a total of 1891 arthroscopic ACL reconstructions were performed at our institution. Twenty-nine cases with post-operative septic knee arthritis following ACL reconstruction were identified and retrospectively analyzed with regard to incidence, clinical presentation, microbiological spectrum, laboratory parameters and number of arthroscopic debridements. Patients were treated with antibiotic therapy (IV and oral) and repeated arthroscopic debridement.
Results: Twenty-nine (1.6%) out of 1891 patients in this study were diagnosed with joint infection following ACL reconstruction with hamstring autograft. All patients presented with pain and swelling of the joint with elevated inflammatory parameters. In majority of cases (62.02%) microbiological analysis failed to identify the causative pathogen and in those where the pathogen was isolated, the most common was Methicilin-resistant Staphylococcus epidermidis (45.45 %). Mean time interval from reconstruction to onset of symptoms was 23.03±19.56 (6-100) days. The mean number of arthroscopic irrigations and debridements was 1.1±0.62 (0-3) per patient. In all twenty-nine cases graft was retained.
Conclusion: Septic arthritis following ACL reconstruction is a rare but serious complication. We conclude that prompt treatment consisting of repeated arthroscopic irrigation and debridement with course of antibiotic therapy is an effective therapeutic intervention that leads to graft and hardware retention.
Knee infection following anterior cruciate ligament reconstruction

ePoster - epESMA-08

Topic: Sports Trauma

Ivkovic A.1,2,3, Kunovac B.4, Janković S.1,5, Vrgoč G.1
1University Hospital Sveti Duh, Orthopaedic Surgery, Zagreb, Croatia, 2University of Zagreb, School of Medicine, Zagreb, Croatia, 3University of Rijeka, Biotechnology, Rijeka, Croatia, 4St. Catherine's Hospital, Zabok, Croatia, 5University of Zagreb, Faculty of Kinesiology, Zagreb, Croatia

Introduction: Septic arthritis following arthroscopic anterior cruciate ligament (ACL) reconstruction is rare with an overall frequency being reported at 0.14- 2.25% of cases. It is a therapeutic emergency and delaying treatment could lead to graft failure, articular cartilage damage and further joint dysfunction. Different treatment options have been proposed, with surgeons generally agreeing on combination of arthroscopic irrigation and debridement with continuous administration of antibiotics lasting 4-6 weeks
Purpose: This study was undertaken to retrospectively determine the incidence of post-operative knee infection following ACL reconstruction, to identify the most common causative pathogen, to evaluate our treatment approach, as well as to review current recommendations for the management of septic arthritis.
Methods: From January 2007 to December 2017, a total of 1891 arthroscopic ACL reconstructions were performed at our institution. Twenty-nine cases with post-operative septic knee arthritis following ACL reconstruction were identified and retrospectively analyzed with regard to incidence, clinical presentation, microbiological spectrum, laboratory parameters and number of arthroscopic debridements. Patients were treated with antibiotic therapy (IV and oral) and repeated arthroscopic debridement.
Results: Twenty-nine (1.6%) out of 1891 patients in this study were diagnosed with joint infection following ACL reconstruction with hamstring autograft. All patients presented with pain and swelling of the joint with elevated inflammatory parameters. In majority of cases (62.02%) microbiological analysis failed to identify the causative pathogen and in those where the pathogen was isolated, the most common was Methicilin-resistant Staphylococcus epidermidis (45.45 %). Mean time interval from reconstruction to onset of symptoms was 23.03±19.56 (6-100) days. The mean number of arthroscopic irrigations and debridements was 1.1±0.62 (0-3) per patient. In all twenty-nine cases graft was retained.
Conclusion: Septic arthritis following ACL reconstruction is a rare but serious complication. We conclude that prompt treatment consisting of repeated arthroscopic irrigation and debridement with course of antibiotic therapy is an effective therapeutic intervention that leads to graft and hardware retention.
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