title: Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol.
abstract: BACKGROUND
  To report the incidence of septic arthritis after anterior cruciate ligament (ACL) reconstruction and management of this complication using a specific treatment protocol.
  
  
  METHODS
  All primary ACL reconstructions performed in our institution between January 2002 and January 2014 were included in this study. Time to presentation, clinical symptoms, and culture results of all infected patients were analyzed. According to our protocol, an arthroscopic debridement and irrigation of the knee joint was performed immediately after a diagnosis of infection was made. In case of recurrence, knee irrigation with hardware and graft removal and later re-implantation was performed. Patients were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) Form, KT 1000 arthrometer and radiographic evaluation.
  
  
  RESULTS
  Postoperative septic arthritis occurred in seven of 1242 patients (0.56%). After initial arthroscopic debridement, infection recurred in six out of seven cases (85%). Graft and hardware removal was performed in these patients. Graft re-implantation was performed in four patients at an average five months after infection. At the final follow-up (mean 6.3years) all patients had full range of motion, while in patients with graft re-implantation the mean Lysholm score was 92, and the mean IKDC score was 87. Radiographs demonstrated that three patients had normal knees and one patient had a grade one, knee arthritis according to Kellgren-Lawrence classification.
  
  
  CONCLUSIONS
  Management of septic arthritis after ACL reconstruction using a specific surgical protocol which includes graft removal in case of infection recurrence with later re-implantation, can provide good and excellent results.
  
  
  METHODS
  Level IV, case series.
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece. Electronic address: hantesmi@otenet.gr.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Hantes
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Vasilios A
authors.initials: VA
authors.lastname: Raoulis
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Doxariotis
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Drakos
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Theofilos
authors.initials: T
authors.lastname: Karachalios
authors.affiliation: The Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Malizos
mesh_terms: D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D001170:Arthritis, Infectious / Q000209:etiology / Q000628:therapy*; D001182:Arthroscopy / Q000009:adverse effects*; D050376:Bone-Patellar Tendon-Bone Grafting; D016022:Case-Control Studies; D002985:Clinical Protocols; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D063868:Patient Outcome Assessment; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D013710:Tendons / Q000637:transplantation; D007507:Therapeutic Irrigation; D055815:Young Adult
keywords: Anterior cruciate ligament reconstruction; Autograft; Knee infection; Re-implantation; Septic arthritis