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. 2025 Aug;33(8):2793-2798.
doi: 10.1002/ksa.12540. Epub 2024 Nov 7.

Zero incidence of culture-positive septic arthritis and low infection rate following ACLR with all-soft tissue quadriceps tendon autograft: An analysis of 1053 cases

Jesse Seilern Und Aspang  1 , John Kopriva  1 , Jason Garry  1 , Rebecca Haley  2 , Austin Collins  1 , Joseph D Lamplot  3 , Harris Slone  4 , John W Xerogeanes  1
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Zero incidence of culture-positive septic arthritis and low infection rate following ACLR with all-soft tissue quadriceps tendon autograft: An analysis of 1053 cases

Jesse Seilern Und Aspang et al. Knee Surg Sports Traumatol Arthrosc. 2025 Aug.

Abstract

Purpose: To evaluate the infection rate following anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (ASTQT) autograft.

Methods: All primary ASTQT autograft ACLRs within a single surgeon's prospectively collected database from 2011 to 2021 were retrospectively reviewed. No topical antibiotics were administered and no graft-soaking with antibiotics was performed during the study period. Patients who underwent multiligament knee reconstruction or a cartilage restoration procedure were excluded. Patients who underwent a subsequent procedure, including irrigation and debridement (I&D) of the knee joint, were included. Case-specific data, including fluid culture analysis, antibiotics (type, route of administration and duration), time to debridement and method of debridement, were collected. Descriptive statistics were utilized to analyze demographics, incidence and possible association between the need for I&D and concomitant meniscus surgery.

Results: Out of 1053 cases (mean age: 20.2 ± 6.3, 44.6% female), four patients (0.38%) (mean age: 18.5 ± 4.0, 25% female) underwent subsequent I&D (arthroscopic I&D only [n = 1], graft harvest site I&D only [n = 1], combined graft harvest site and arthroscopic I&D [n = 1] and tibia wound and arthroscopic I&D [n = 1]). There was no significant difference with regard to demographics. No joint fluid cultures returned positive; one wound culture returned positive for Methicillin-susceptible Staphylococcus aureus from their graft harvest site. The time to I&D ranged from 18 to 23 days. Concomitant meniscectomy or meniscal repair was not associated with requiring surgical I&D. All patients who underwent I&D were prescribed antibiotics for a minimum of 10 days and a maximum of 31 days (mean: 16.25 days). Three patients (75%) who underwent I&D ultimately returned to sport. One patient was lost to follow-up. ACL grafts were retained in all patients.

Conclusion: The incidence of culture-positive septic arthritis following ASTQT autograft ACLR is 0%, while the overall need for I&D of 0.38% is low and not related to concomitant meniscal procedures or patient-specific factors.

Level of evidence: Level IV.

Keywords: all‐soft tissue quadriceps tendon; anterior cruciate ligament reconstruction; infection; quadriceps tendon autograft; septic arthritis.

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References

REFERENCES

    1. Abdel‐Aziz, A., Radwan, Y.A. & Rizk, A. (2014) Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case‐control study. International Orthopaedics, 38, 73–82. Available from: https://doi.org/10.1007/s00264-013-2123-y
    1. Barker, J.U., Drakos, M.C., Maak, T.G., Warren, R.F., Williams, R.J. & Allen, A.A. (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 38, 281–286. Available from: https://doi.org/10.1177/0363546509346414
    1. Bergstein, V.E., Ahiarakwe, U., Haft, M., Fox, H. & Best, M.J. (2024) Decreasing incidence of anterior cruciate ligament tears and increasing utilization of anterior cruciate ligament reconstruction in the United States from 2010 to 2020. Arthroscopy, 24, S0749‐8063. Available from: https://doi.org/10.1016/j.arthro.2024.08.01810.1016/j.arthro.2024.08.018
    1. Bratzler, D.W., Dellinger, E.P., Olsen, K.M., Perl, T.M., Auwaerter, P.G., Bolon, M.K. et al. (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surgical Infections, 14, 73–156. Available from: https://doi.org/10.1089/sur.2013.9999
    1. Cassano, G.D., Moretti, L., Vicenti, G., Buono, C., Albano, F., Ladogana, T. et al. (2024) Infection after anterior cruciate ligament reconstruction: a narrative review of the literature. Healthcare, 12, 894. Available from: https://doi.org/10.3390/healthcare12090894

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