Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction

Monaco, Edoardo; Maestri, Barbara; Labianca, Luca; Speranza, Attilio; Vadalà, Antonio; Iorio, Raffaele; Ferretti, Andrea

doi:10.1007/s00776-009-1447-3

Cited by 32 publications

(37 citation statements)

References 23 publications

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“…In fact, in four of 15 patients, this difference was ≤1 mm. Monaco et al [40], in a series with 14 infections, observed a mean KT-1000 side-toside difference of 2.5 mm (follow-up, 38 months) and Binnet et al [20] observed that this value was 2.7 mm (follow-up, 102 months). It seems that, if the graft can be maintained, the laxity obtained in most cases is similar to those patients who have not had an infection.…”

Section: Functional Outcomesmentioning

confidence: 96%

“…In addition, most series only reported very short follow-up results [8,9,14]. Different authors considered a mean Lysholm score of 65.6 [13] or 69.5 [40] to be satisfactory. More in accordance with current standards of satisfactory results, Lysholm score >90 points [5,14,15,41] has also been reported.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…Conversely, the control group had a mean Lysholm score of 90.7 and a mean IKDC of 86.6. Surprisingly enough, Monaco et al [40] reported on a series of patients who were able to return to preoperative sports at the same level. Shulz et al [13] reported a 60-day mean time to diagnose the infection, and in one case, a total joint arthroplasty had to be performed five years after ACLR.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…Viola et al[5] chose antibiotic treatment with ciprofloxacin plus amoxicillin/clavulanic acid for a period of 15-90 days; in >40 % of cases, treatment failed, and patients required an arthroscopic lavage. Monaco et al[40] described antibiotic therapy along with repeated joint irrigation; that treatment failed in 30 % of patients and required an arthroscopic lavage. Contrary to those results, Wang et al[16] presented a series with 21 cases of infection following an ACLR, some of which were treated conservatively.…”

mentioning

confidence: 99%

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Managing septic arthritis after knee ligament reconstruction

Torres-Claramunt

Gelber

Pelfort

et al. 2015

International Orthopaedics (SICOT)

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Section: Functional Outcomesmentioning

confidence: 96%

Section: Functional Outcomesmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Managing septic arthritis after knee ligament reconstruction

Torres-Claramunt

Gelber

Pelfort

et al. 2015

International Orthopaedics (SICOT)

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“…However, most of these studies are retrospective and probably underpowered, which means that this statement should be regarded with some caution [7][8][9].…”

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confidence: 99%

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Eriksson

Karlsson

2016

Knee Surg Sports Traumatol Arthrosc

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treatment has become the first line of treatment unless contraindicated.It is obvious that, with improved results in both the short and long term [function and risk of osteoarthritis (OA)] and a simultaneous reduced risk of complications and morbidity related to the procedure, more people could benefit from surgery. For this reason, reducing morbidity after ACL reconstructive procedures must be a significant part of the "ACL holy grail".The incidence of deep post-operative infection following an ACL reconstruction varies between 0.14 and 1.7 % in different studies [2,12]. The majority of the present studies report an incidence of just below 1 %. Moreover, there are some signs that hamstring grafts are slightly more likely to be infected compared with patellar tendon (BTB) grafts. In terms of pathogens, coagulase-negative staphylococcus (CNS) appears to be the dominant species, followed by staphylococcus aureus and propionebacterium acne. The most likely aetiology is graft contamination from the patient's own skin flora.The potential consequences of a deep infection can obviously be devastating, with the need for graft and hardware removal, and in many patients, a second stage ACL-R 4 to 6 months later. However, in most cases, repeated washouts and long-term antibiotics cure the infection, and the graft may survive. The two major concerns following deep infection after ACL-R are graft survival and long-term graft function, but also the increased likelihood of long-term OA. In a recent publication by Boström Windhamre et al. [1], 27 of 43 reported infected ACL-Rs were compared with matched controls in terms of activity, time to recovery and knee function. The infection rate was estimated at 0.98 %.The recovery time was significantly longer, and the Tegner activity level was lower, while the KOOS values at a mean of 60 months post-operatively revealed no ACL reconstruction (ACL-R) in 2016 still faces two major challenges. The first is to improve the surgical technique and consequently the overall results, and the second is to minimise the morbidity of the procedure. The fact is that, if significant improvements in both these areas can be achieved, we would most probably offer surgical treatment (repair or reconstruction) as the first line of treatment to most young and middle-aged patients sustaining an ACL rupture. This argument could be compared with tibial fractures or other traumatic conditions, where surgical

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Zero incidence of culture‐positive septic arthritis and low infection rate following ACLR with all‐soft tissue quadriceps tendon autograft: An analysis of 1053 cases

Seilen und Aspang,

Kopriva,

Garry

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all‐soft tissue quadriceps tendon (ASTQT) autograft.MethodsAll primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft‐soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case‐specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery.ResultsOut of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin‐susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow‐up. ACL grafts were retained in all patients.ConclusionThe incidence of culture‐positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient‐specific factors.Level of EvidenceLevel IV.

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Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction

Cited by 32 publications

References 23 publications

Managing septic arthritis after knee ligament reconstruction

Managing septic arthritis after knee ligament reconstruction

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Zero incidence of culture‐positive septic arthritis and low infection rate following ACLR with all‐soft tissue quadriceps tendon autograft: An analysis of 1053 cases

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