Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol

Hantes, Michael; Raoulis, Vasileios; Doxariotis, Nikolaos; Drakos, Athanasios; Karachalios, Theofilos; Malizos, Konstantinos N.

doi:10.1016/j.knee.2017.02.007

Cited by 23 publications

(31 citation statements)

References 22 publications

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“…Opponents of graft preservation argue that the graft, if left in place, will remain a source of infection[1]. Kim et al[2] reported that an average of 1.9 procedures were needed for complete eradication of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical site infections following arthroscopic anterior cruciate ligament (ACL) reconstruction are uncommon. Current literature suggests the incidence rate to be around 1.7%[1-3] with almost all cases presenting in the acute or subacute post-operative periods[1,2,4-6]. Prompt diagnosis and treatment are necessary to avoid devastating consequences such as septic arthritis and its sequelae[7].…”

Section: Introductionmentioning

confidence: 99%

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Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

Koh¹,

Tan²,

Tan³

2019

WJO

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BACKGROUND Surgical site infections following anterior cruciate ligament (ACL) reconstruction are an uncommon but potentially devastating complication. In this study, we present an unusual case of recurrent infection of the knee after an ACL reconstruction, and discuss the importance of accurate diagnosis and appropriate management, including the issue of graft preservation versus removal. CASE SUMMARY A 33-year-old gentleman underwent ACL reconstruction using a hamstring tendon autograft with suspensory Endobutton fixation to the distal femur and an interference screw fixation to the proximal tibia. Four years after ACL reconstruction, he developed an abscess over the proximal tibia and underwent incision and drainage. Remnant suture material was found at the base of the abscess and was removed. Five years later, he re-presented with a lateral distal thigh abscess that encroached the femoral tunnel. He underwent incision and drainage of the abscess which was later complicated by a chronic discharging sinus. Repeated magnetic resonance imaging revealed a fistulous communication between the lateral thigh wound extending toward the femoral tunnel with suggestion of osteomyelitis. Decision was made for a second surgery and the patient was counselled about the need for graft removal should there be intra-articular involvement. Knee arthroscopy revealed the graft to be intact with no evidence of intra-articular involvement. As such, the decision was made to retain the ACL graft. Re-debridement, excision of the sinus tract and removal of Endobutton was also performed in the same setting. Joint fluid cultures did not grow bacteria. However, tissue cultures from the femoral tunnel abscess grew Enterobacter cloacae complex, similar to what grew in tissue cultures from the tibial abscess five years earlier. In view of the recurrent and indolent nature of the infection, antibiotic therapy was escalated from Clindamycin to Ertapenem. He completed a six-week course of intravenous antibiotics and has been well for six months since surgery, with excellent knee function and no evidence of any further infection. CONCLUSION Prompt and accurate diagnosis of surgical site infection following ACL reconstruction, including the exclusion of intra-articular involvement, is important for timely and appropriate treatment. Arthroscopic debridement and removal of implant with graft preservation, together with a course of antibiotics, is a suitable treatment option for extra-articular knee infections following ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

Koh¹,

Tan²,

Tan³

2019

WJO

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“…The total local anesthetic amounts given to the patients in our study did not exceed the recommended [29] maximum safe dose of 2 mg/kg for bupivacaine and 7 mg/kg for prilocaine, and no side effects were observed. Many studies have previously reported successful results regarding the surgical treatment of septic knee arthritis arthroscopically [30][31][32]. However, under local anesthesia, there are few studies in which this procedure is applied [33].…”

Section: Discussionmentioning

confidence: 99%

Mini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report

Ceylan¹

2018

Ann Clin Anal Med

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Surgical treatment of knee septic arthritis with local anesthesiaMini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report DOI: 10.4328 AbstractAim: Good pain management is provided via spinal and general anesthesia during knee joint drainage to treat septic arthritis, but the side effects are greater than those associated with local anesthesia, and the preparation process is long. Arthroscopic drainage under local anesthesia for knee septic arthritis treatment have been described, but this method requires special equipment. In this study, we aimed to evaluate the applicability of mini-open surgery under local anesthetic infiltration in cases of septic knee arthritis. Material and Method: 14 consecutive patients (eight men, six women) were admitted for knee septic arthritis treatment. Patient age ranged from 18 to 56 years, with an average age of 33 years. Drainage procedure was performed under local anesthesia, and the results were evaluated clinically. Results: The visual analog scale scores were between two and four (mean 2.8). The follow-up period was 10-21 months (mean 14.3). The Tegner and International Knee Documentation Committee scores were acceptable except for one patient. Discussion: This prospective study included mini-open surgery performed under local anesthesia on 14 septic knees, and showed that this method is safe, effective, well tolerated and be alternative to conventional techniques.

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“…Los Staphylococcus aureus y Staphylococcus coagulasa negativos (fundamentalmente Staphylococcus epidermidis) son las bacterias más comunes que se encuentran en la mayoría de las series (2)(3)(4)(5) . Este hecho debe ser considerado cuando se inicia el tratamiento antibiótico empírico, ya que Staphylococcus es un microorganismo capaz de formar un biofilm que lo protege de los antimicrobianos, lo que dificulta su erradicación.…”

Section: Etiopatologíaunclassified

“…Cuando la infección ya se ha producido, el tratamiento de elección debe ser realizado tan pronto como sea posible y en cuanto haya sospecha clínica de infección, refrendada o no por los resultados de las pruebas complementarias, los cuales no justifican una demora en la actuación. Este tratamiento consiste en asociar un desbridamiento artroscópico agresivo al inicio del tratamiento antibiótico (4)(5)9) . Durante el desbridamiento artroscópico es obligatorio recoger muestras para el cultivo antes de la administración de antibióticos, y ambas terapias deben realizarse lo antes posible.…”

Section: Tratamientounclassified

Artritis séptica de rodilla tras artroscopia de reconstrucción de ligamento cruzado anterior

Villanueva-Martínez¹,

Sutil-Blanco²,

Hernández-Seoane³

et al. 2019

RETLA

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Introducción: la infección articular de rodilla tras cirugía de reconstrucción de ligamentos cruzados es infrecuente, pero con consecuencias potencialmente graves para la articulación. Publicaciones recientes han demostrado que debe realizarse un desbridamiento artroscópico precoz asociado al tratamiento antibiótico para preservar la plastia y el cartílago articular. Asimismo, se enumeran marcadores de laboratorio útiles para el diagnóstico precoz de esta complicación. Métodos: revisión bibliográfica de series recientes publicadas. Resultados: en la presente revisión se discuten los parámetros de laboratorio para el diagnóstico de artritis séptica tras cirugía de reconstrucción de LCA y el protocolo de tratamiento, así como sus resultados en distintas publicaciones.

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Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol

Cited by 23 publications

References 22 publications

Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

Recurrent surgical site infection after anterior cruciate ligament reconstruction: A case report

Mini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report

Artritis séptica de rodilla tras artroscopia de reconstrucción de ligamento cruzado anterior

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