Tubercular infection after arthroscopic anterior cruciate ligament reconstruction.
OBJECTIVE
Tubercular infection has not been described, to our knowledge, in the literature after anterior cruciate ligament (ACL) reconstruction, and, hence, the purpose of our case series was to describe our experience, evaluate the clinical and laboratory findings, and assess the treatment outcome.


METHODS
We performed a retrospective analysis of 1,152 cases of arthroscopic ACL reconstruction with autografts performed at our institution between January 1998 and May 2007. Tubercular infection was considered to be present in the setting of recurrent negative bacterial cultures but a positive result on microscopy, culture, histopathology, or polymerase chain reaction (PCR). All patients underwent arthroscopic lavage and synovectomy, followed by antitubercular therapy for 12 months.


RESULTS
We identified 8 patients (0.69%) with infection. Bone-patellar tendon-bone graft was used in 1 and hamstring graft in 7. All patients were immunocompetent. The mean time from surgery to presentation was 64.4 days (range, 23 to 152 days). Aspirate fluid staining and culture for acid-fast bacilli was negative in all cases, synovial tissue culture was positive in 3, characteristic histopathology was positive in 7, and PCR was positive in 6. A mean of 1.25 surgeries (range, 1 to 2) were performed. The mean length of follow-up in our series was 43.6 months (range, 25 to 73 months), with no reinfections. The mean postoperative Lysholm knee score was 80.


CONCLUSIONS
Tubercular infection as a complication after arthroscopic ACL reconstruction, though rare, should be kept in mind as a possible cause of infection in immunocompetent patients in zones endemic for tuberculosis. It should also be kept in mind in nonendemic areas, among immigrants from endemic areas, and in cases with persistent swelling and discharge, effusion with minimal inflammatory signs, and negative cultures. We recommend deoxyribonucleic acid-PCR testing for early diagnosis of tuberculosis. Arthroscopic debridement and antitubercular chemotherapy together are the mainstay of treatment.
Nag
Hira Lal
HL
Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. hlnag@hotmail.com
Neogi
Devdatta Suhas
DS
Nataraj
A R
AR
Kumar
V Ajay
VA
Yadav
Chandra Shekhar
CS
Singh
Urvashi
U
D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D000995:Antitubercular Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D001182:Arthroscopy / Q000379:methods*; D001863:Bone Screws; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000382:microbiology* / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D000070600:Tibial Meniscus Injuries; D014394:Tuberculosis, Osteoarticular / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D055815:Young Adult
D000995:Antitubercular Agents