Infection After Arthroscopic Anterior Cruciate Ligament Reconstruction

Educational objectives As a result of reading this article, physicians should be able to: 1. Identify the most common pathogen of infection after anterior cruciate ligament (ACL) reconstruction. 2. Outline the general principles for the treatment of infection after ACL reconstruction. 3. Determine the indications of graft excision and hardware removal. 4. Summarize the outcomes of infection after ACL reconstruction. Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4–218 months). An average of 1.92 procedures (range, 1–5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5–90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23–100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment. [ Orthopedics. 2014; 37(7):477–484.]