title: Factors associated with infection following anterior cruciate ligament reconstruction.
abstract: BACKGROUND
  Although rare, infection can be devastating after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to test the association between infection after ACL reconstruction and potential risk factors such as age, body mass index (BMI), smoking, diabetes, and graft choice.
  
  
  METHODS
  We reviewed the Multicenter Orthopaedic Outcomes Network (MOON) cohort from 2002 to 2005 to identify patients with a postoperative infection. The age, BMI, smoking status, history of diabetes, and graft choice were recorded for each patient. A multivariable regression analysis was constructed to examine which baseline risk factors were independently associated with postoperative infection after ACL reconstruction requiring surgical intervention.
  
  
  RESULTS
  There were 2198 eligible patients in the cohort, with seventeen (0.8%) reporting a postoperative infection. Diabetes was found to be a significant risk factor for infection (odds ratio [OR] = 18.8; 95% confidence interval [CI] = 3.8 to 94.0; p < 0.001). Compared with bone-tendon-bone autograft, both hamstring autograft and other grafts (e.g., the majority of allografts, with some that were both autograft and allograft) also increased the risk of infection (OR = 4.6 [95% CI = 1.2 to 17.9; p = 0.026] for hamstrings and 4.3 [95% CI = 1.0 to 18.1; p = 0.047] for other grafts). Although the OR for infection in smokers was 2.5, this finding did not reach significance.
  
  
  CONCLUSIONS
  Patients with diabetes undergoing ACL reconstruction have a significantly elevated risk of postoperative infection (18.8-times higher odds) compared with that for patients without diabetes. Use of bone-tendon-bone autograft is associated with a lower risk of infection after ACL reconstruction.
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017.
authors: Robert H
authors: RH
authors: Brophy
authors: Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110.
authors: Rick W
authors: RW
authors: Wright
authors: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232.
authors: Laura J
authors: LJ
authors: Huston
authors: Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 11000, Nashville, TN 37203.
authors: Samuel K
authors: SK
authors: Nwosu
authors: Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125.
authors: Kurt P
authors: KP
authors: Spindler
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D015992:Body Mass Index; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013530:Surgical Wound Infection / Q000209:etiology*; D013710:Tendons / Q000637:transplantation; D014182:Transplantation, Autologous; D055815:Young Adult