Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques

Abstract

Purpose: Infection after arthroscopic anterior cruciate ligament (ACL) reconstruction is reported to be rare but can cause significant morbidity. The purpose of this study was to test the null hypothesis that there is no difference in infection rates between techniques and no difference in outcome of different techniques after treatment of this complication.

Methods: From a consecutive case series of 1,231 patients who underwent ACL reconstructions with 3 different techniques from 1988 through 2006, we report 6 patients who developed postoperative infection. Time to presentation, clinical symptoms, patient demographics, and surgical and management details were obtained from patient charts. All 6 patients were re-examined with physical and radiographic evaluation, functional testing, KT-1000 (Medmetric, San Diego, CA), and Lysholm scales.

Results: Six patients (0.49%) were identified including 2 infections for each technique with incidence of 0.86%, 0.29%, and 0.64%, respectively. The graft was retained in all 6 patients and treated with debridement and continuous antibiotics. Metallic implant was removed in 5 cases. Patients were followed up for an average of 102.5 months. The average modified Lysholm score was 81.1. The average maximum manual KT-1000 value was 2.7 mm. A Kruskal-Wallis test was used for statistical analysis, and no significant differences were noted in incidence, mean Lysholm scores, or KT-1000 difference (P > .05).

Conclusions: Aggressive surgical debridement, hardware removal, and appropriate antibiotic therapy have proven effective in eliminating postsurgical infection along with graft retention and preservation of knee stability after ACL reconstruction performed with 3 different techniques. Although it was a small case series, the incidence and outcome after treatment of ACL infection in our study is similar, supporting the hypothesis that treatment outcomes were similar by using different surgical methods.

Level of evidence: III, retrospective comparative study.