Infections following arthroscopic anterior cruciate ligament reconstruction.
OBJECTIVE
Infection after anterior cruciate ligament (ACL) reconstruction is a serious but uncommon complication. Optimal management has not been established. The purpose of our case series was to review our experience and published reports to identify risk factors, evaluate physical and laboratory findings, compare different treatments, and assess clinical outcomes.


METHODS
Retrospective review of all the arthroscopic ACL reconstructions performed at our institution between 1994 and 2002. Patients with intra-articular infections were evaluated and, when available, comparisons were made between patients with extra-articular infections and uncomplicated postoperative ACL reconstructions.


RESULTS
Eleven postoperative infections were identified, all in patients who had hamstring autograft. Previous knee surgery, especially previous ACL reconstruction and tibial ACL graft fixation with a post and washer, was associated with increased infection. Laboratory data revealed elevated erythrocyte sedimentation rate (average, 67), C-reactive protein (average, 14), and intra-articular blood cell count (average, 52,000). All infections were eradicated with serial arthroscopic incision and drainage (average, 2.4 procedures) and intravenous antibiotics (duration, 14 to 42 days). The graft was retained in 10 of 11 patients. At an average follow-up of 22 months, the average Lysholm functional knee score was 71.6 out of 100 points (range, 36-99). Of the 5 patients with fair/poor results, the most common chief complaint was pain and stiffness.


CONCLUSIONS
Long-term goals for treatment of patients with postoperative ACL infections are to protect the articular cartilage and to maintain knee function. Timely initiation of treatment, including joint lavage, debridement, and antibiotics, are essential to treatment. Graft and hardware retention can successfully accomplish these long-term goals. However, if early clinical response is not acceptable, strong consideration should be given to expedient graft and hardware removal. Excellent outcomes can be obtained, but results are usually lower than with uncomplicated cases.


METHODS
Level IV, case series.
Judd
Daniel
D
Womack Army Medical Center, Department of Orthopaedic Surgery and Rehabilitation, Fort Bragg, North Carolina 28310, USA. Daniel.Judd@amedd.army.mil
Bottoni
Craig
C
Kim
David
D
Burke
Matthew
M
Hooker
Shawn
S
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001182:Arthroscopy; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D003131:Combined Modality Therapy; D003646:Debridement; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D013530:Surgical Wound Infection / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D007507:Therapeutic Irrigation; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein