Purpose
To determine whether the outcome after septic arthritis after anterior cruciate ligament
reconstruction (ACLR) is inferior compared with uncomplicated ACLR when treated promptly
by use of a standard protocol.
Methods
At Capio Artro Clinic, 4,384 primary ACLRs were performed during 2001-2009. All patients
with postoperative septic arthritis were retrospectively reviewed, and 43 met the
inclusion criteria. Twenty-seven patients agreed to re-examination (infection group)
and were compared with 27 matched patients with uncomplicated ACLR (control group).
The mean follow-up period was 60 months and 66 months in the infection group and control
group, respectively. Re-examination included objective (radiographs, physical examination,
functional testing, range of motion, strength, stability, International Knee Documentation
Committee questionnaire) and subjective (Knee Injury and Osteoarthritis Outcome Score,
Tegner score, Lysholm score, European Quality of Life–5 Dimensions, subjective satisfaction
questions, Single Assessment Numeric Evaluation of knee function, visual analog scale
pain rating) evaluation.
Results
There were no significant differences in objective knee function between the groups
at follow-up. For subjective knee function, no significant differences between the
groups were detected with the Single Assessment Numeric Evaluation score, pain during
activity, or Lysholm score. The infection group scored lower on 4 of 5 Knee Injury
and Osteoarthritis Outcome Score subscales: pain (P = .014), function in daily living (P = .008), sports/recreation (P = .015), and quality of life (P = .007). The infection group scored lower versus control patients on the Tegner score
(P = .001) and European Quality of Life–5 Dimensions scores (P = .004). Both groups improved over time, but the control group scored better only
on the Tegner score (P = .004).
Conclusions
Septic arthritis after ACLR did not result in inferior objective knee function compared
with uncomplicated ACLR. Subjectively, infection patients were as satisfied as non-infection
patients, but rehabilitation took longer and fewer patients returned to sports. The
findings of this study suggest that anterior cruciate ligament grafts may be retained
with prompt, thorough arthroscopic lavage and debridement; correct antibiotics according
to cultures; and repeated arthroscopy if necessary.
Level of Evidence
Level III, retrospective case-control therapeutic study.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Swedish National Knee Ligament Register. Annual report 2010. Available from: URL: http://www.artroclinic.se/info/rapport2010en.pdf. Accessed September 14, 2011.
- A population-based nationwide study of cruciate ligament injury in Sweden, 2001-2009: Incidence, treatment, and sex differences.Am J Sports Med. 2012; 40: 1808-1813
- Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques.Arthroscopy. 2007; 23: 862-868
- Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation.Am J Sports Med. 2003; 31: 414-418
- Septic arthritis after arthroscopic anterior cruciate ligament reconstruction.Ann Acad Med Singapore. 2004; 33: 228-234
- Septic arthritis in postoperative anterior cruciate ligament reconstruction.Clin Orthop Relat Res. 2002; : 182-188
- Infections following arthroscopic anterior cruciate ligament reconstruction.Arthroscopy. 2006; 22: 375-384
- A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft.Arthroscopy. 2008; 24: 1330-1335
- Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction.Am J Sports Med. 1999; 27: 562-570
- Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction.J Orthop Sci. 2010; 15: 198-203
- Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: A case control study.Arthroscopy. 2003; 19: 941-947
- Septic arthritis of the knee after anterior cruciate ligament surgery: A stage-adapted treatment regimen.Am J Sports Med. 2007; 35: 1064-1069
- Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: A retrospective analysis of incidence, management and outcome.Am J Sports Med. 2007; 35: 1059-1063
- Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: A retrospective analysis of incidence, presentation, treatment, and cause.Arthroscopy. 2009; 25: 243-249
- Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management.Am J Sports Med. 1997; 25: 261-267
- An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function.Arthroscopy. 2000; 16: 173-177
- Inhibiting the inflammatory response in joint sepsis.Arthroscopy. 2001; 17: 311-315
- Bacterial (suppurative) arthritis in the adult.J Bone Joint Surg Am. 1970; 52: 1595-1602
- Septic knee arthritis following ACL reconstruction: A systematic review.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1033-1042
Wang C, Lee YH, Siebold R. Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc in press, available online 6 September, 2013. http://dx.doi.org/10.1007/s00167-013-2648-z.
- Evaluation of knee ligament injuries with the IKDC form.Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
- Knee injury and Osteoarthritis Outcome Score (KOOS)—Validation of a Swedish version.Scand J Med Sci Sports. 1998; 8: 439-448
- Knee Injury and Osteoarthritis Outcome Score (KOOS)—Development of a self-administered outcome measure.J Orthop Sports Phys Ther. 1998; 28: 88-96
- Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale.Am J Sports Med. 1982; 10: 150-154
- Rating systems in the evaluation of knee ligament injuries.Clin Orthop Relat Res. 1985; : 43-49
- EuroQol—A new facility for the measurement of health-related quality of life.Health Policy. 1990; 16: 199-208
- Comparison of the single assessment numeric evaluation method and the Lysholm score.Clin Orthop Relat Res. 2000; 373: 184-192
- The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.Pain. 1983; 17: 45-56
- Osteoarthrosis of the knee. A radiographic investigation.Acta Radiol Diagn (Stockh). 1968; : 7-72
- The Knee injury and Osteoarthritis Outcome Score (KOOS): From joint injury to osteoarthritis.Health Qual Life Outcomes. 2003; 1: 64
- Treatment of persistent infection after anterior cruciate ligament surgery.Clin Orthop Relat Res. 2005; 439: 52-55
- Septic arthritis following arthroscopy: Clinical syndromes and analysis of risk factors.Arthroscopy. 1992; 8: 213-223
- Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction.Arthroscopy. 2012; 28: 667-671
- Septic arthritis of the knee: A 10-year review and long-term follow-up using a new scoring system.Scand J Infect Dis. 1994; 26: 85-93
- Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction.Am J Sports Med. 2010; 38: 281-286
- Incidence of postoperative anterior cruciate ligament reconstruction infections: Graft choice makes a difference.Am J Sports Med. 2013; 41: 1780-1785
Article info
Publication history
Published online: May 15, 2014
Accepted:
March 21,
2014
Received:
July 8,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: C.M. received support from Capio Research Foundation (grant #2011-1991) for help with statistical analyses, and editing, and translation of the manuscript.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
