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. 2018 Mar 1;6(3):2325967118758626.
doi: 10.1177/2325967118758626. eCollection 2018 Mar.

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal

Brian R Waterman  1 , William Arroyo  2 , Eric J Cotter  3 , Michael A Zacchilli  4 , E'Stephan J Garcia  2 , Brett D Owens  5
Affiliations

Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal

Brian R Waterman et al. Orthop J Sports Med. .

Abstract

Background: There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis.

Purpose: To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention.

Study design: Case series; Level of evidence, 4.

Methods: The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes.

Results: Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty (P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group.

Conclusion: Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee stability (100%), although the rate of return to active duty was low in the graft resection group (33%). The risk of knee laxity did not differ based on early graft retention. Time to presentation with graft retention was not associated with a decreased rate of graft laxity.

Keywords: anterior cruciate ligament; anterior cruciate ligament reconstruction; laxity; septic arthritis.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.R.W. receives publishing royalties from Elsevier and is a paid consultant for Genzyme. B.D.O. is a paid consultant for Conmed Linvatec, Mitek, and the Musculoskeletal Research Foundation; receives research support from Histogenics; and receives publishing royalties from Saunders/Mosby-Elsevier and Springer.

Figures

Figure 1.
Figure 1.
Clinical outcomes depicted in a decision tree format based initially on if the anterior cruciate ligament (ACL) graft was retained after treatment for septic arthritis. The graft was retained in 71% of patients, but only 15 of those 22 patients (68%) maintained knee stability without revision ACL reconstruction.
See this image and copyright information in PMC

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