Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articleInfections Following Arthroscopic Anterior Cruciate Ligament Reconstruction
Section snippets
Methods
A retrospective review was performed of all arthroscopic ACL reconstructions performed at our institution from January 1994 to December 2001. Postoperative intra-articular infections were defined as a positive culture from a knee aspiration or a cell count consistent with intra-articular infection (>10,000 cells/mL) in patients who presented with symptoms consistent with septic arthritis. Workup for infections was performed at the discretion of the attending physician, typically in conjunction
Results
Out of the 1,615 ACL reconstructions performed between January 1994 and December 2001, 11 patients (0.68%) were identified with postoperative septic arthritis. However, the 11 intra-articular infections all occurred during a 3-year period between 1999 and 2001, resulting in an incidence rate of 2.6%. We analyzed the operative reports of all 418 ACL reconstructions performed during this period of increased incidence of infection for operative variables and patient demographics. Additionally,
Discussion
In a review of the literature, we identified 5 published case series addressing postoperative ACL infections.2, 3, 4, 6, 7 Data from these reports are summarized in Table 8, Table 9. Most investigators reported similar patient presentations, with classic signs of joint infections, rapid increase in effusion, knee pain, local erythema, and incisional drainage. As noted by others, the diagnosis may not be as obvious and classic signs of knee sepsis can be masked by postoperative changes; in
Conclusions
The long-term goals of treatment of patients with postoperative ACL infections are to protect the articular cartilage and to maintain knee function. Graft retention and eradication of infection are not sufficient measures of successful treatment. Timely initiation of treatment, including joint lavage, debridement, and administration of antibiotics, are essential to remove bacterial contamination and to minimize chondrolysis. Based on our experience and literature review, graft and hardware
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