Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case–control study

Abstract

Graft retention seems not only possible but appropriate in view of the experience presented in this article for postoperative septic knee arthritis using hamstring autograft. A potential residual complication is arthrofibrosis, which deserves maximum attention.

Patients treated with surgical irrigation and debridement for infection after ACL reconstruction have a high rate of subsequent knee surgery

“…In a recent systematic review pooling reports from prior studies of patients with infections following ACLR, the average IKDC score was 68.2 at mean follow-up of 44.2 months, which was slightly lower than our scores at 2-year and 6-year follow-up 22. In another recent study reporting 5-year follow-up in a similar patient population,15 the mean KOOS symptoms score was 86, KOOS pain was 82, KOOS ADL was 96, KOOS sports/recreation was 90 and KOOS QOL was 84; all very close to our reported values at 6-year follow-up. The PROs in the patients who underwent I&D were similar to or slightly worse than PROs reported for ACLR patients as a whole 23 24.…”

“…They also reported an average of 1.9 procedures per patient after ACLR, which is very similar to our average of 1.8. In a recent case series similar to ours,15 the average number of procedures was 3.6, mostly due to a high rate of repeat washouts (median of 3).…”

Postoperative Infection After Anterior Cruciate Ligament Reconstruction

“…The literature search identified 16 articles on post-ACLR infection published during the past decade: 2 studies 1 , 14 were level 2, 6 studies 3 , 4 , 12 , 16 , 21 , 23 were level 3, and 8 studies 5 , 6 , 10 , 11 , 22 , 24 , 25 , 27 were level 4 (Tables 2-5 in the Appendix, available at http://sph.sagepub.com/content/by/supplemental-data ). Among 35,795 ACLRs in the reviewed studies, 246 infections were identified, resulting in a mean incidence of 0.68% (range, 0.14%-2.6%).…”

Post-arthroscopy septic arthritis: Current data and practical recommendations

“…The antibiotics are selected based on the organisms recovered from the deep specimens collected during arthroscopic lavage. Implants and transplants are almost always left in place [4,8,9,[16][17][18][19]. When the course is unfavourable, with a persistent painful effusion, a fever, laboratory evidence of systemic inflammation, and/or positive drainage fluids, arthroscopic lavage should be performed as many times as needed, implant exchange should be considered (if readily achievable), and every effort should be made to preserve any transplants when possible [8][9][10].…”

“…When the course is unfavourable, with a persistent painful effusion, a fever, laboratory evidence of systemic inflammation, and/or positive drainage fluids, arthroscopic lavage should be performed as many times as needed, implant exchange should be considered (if readily achievable), and every effort should be made to preserve any transplants when possible [8][9][10]. With this protocol (arthroscopic synovectomy, transplant preservation, and antibiotics for 6 weeks), eradication of the infection is achieved in 85% to 100% of cases [4,13,[15][16][17][18][19]. Despite a slower pace of recovery, the functional outcomes are identical to those seen in the absence of post-ACL reconstruction infection [8,9,11,16,[20][21][22].…”