Functional Outcome and Graft Retention in Patients With Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review.
OBJECTIVE
To provide a comprehensive review of clinical and functional outcomes after treatment for septic arthritis after anterior cruciate ligament reconstruction.


METHODS
A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic quality of each study. Studies that met the inclusion criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means.


RESULTS
Nineteen studies met the inclusion and exclusion criteria for this review, reporting on a total of 203 infected knees. The mean age was 27.5 years and the mean length of follow-up was 44.2 months, with male patients comprising 88% of the population. Hamstring and bone-patellar tendon-bone autografts were used in 63% and 33% of patients, respectively, with 78% of patients retaining their grafts. The studies reported mean flexion and extension deficits of 5.8° and 1.0°, respectively, and laxity testing showed a mean difference of 1.9 mm. The studies reported mean Lysholm, International Knee Documentation Committee, and Tegner scores of 82.1, 68.2, and 5.6, respectively. Of the patients, 83% reported an ability to return to activities of daily living whereas 67% reported a return to their preinjury level of athletics. Evidence of new degenerative changes was seen in 22% of patients.


CONCLUSIONS
Septic arthritis after anterior cruciate ligament reconstruction remains a very infrequent event, affecting 0.5% of patients. On average, outcomes in these patients are comparable with those in patients in whom infection does not develop, including postoperative range of motion, residual instability, Lysholm scores, and return to preinjury level of activity. These patients do exhibit decreased International Knee Documentation Committee scores compared with patients without septic arthritis, however. The impact of this differential is not clear, but this scoring difference suggests that septic arthritis may be associated with more severe symptoms and reduced functional outcomes. In addition, there is limited evidence suggesting that septic arthritis leads to early degenerative changes found on imaging.


METHODS
Level IV, systematic review of Level III and IV studies.
Columbia University Medical Center, New York, New York, U.S.A.
Eric C
EC
Makhni
Columbia University Medical Center, New York, New York, U.S.A.
Michael E
ME
Steinhaus
Henry Ford Hospital, Wayne State University, Detroit, Michigan, U.S.A.
Nima
N
Mehran
Kerlan-Jobe Orthopedic Clinic, Los Angeles, California, U.S.A.
Brian S
BS
Schulz
Columbia University Medical Center, New York, New York, U.S.A.. Electronic address: csa4@columbia.edu.
Christopher S
CS
Ahmad
D000203:Activities of Daily Living; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome