Septic Arthritis Following Arthroscopic Anterior Cruciate Ligament Reconstruction

AIMS AND OBJECTIVES: To determine the incidence of postoperative septic arthritis following primary and revision ACL-reconstruction, to identify the microbiological spectrum, and to evaluate a graft-retaining treatment protocol consisting of sequential arthroscopic revisions. MATERIALS AND METHODS: From January 2004 to June 2014 a total of 7,096 consecutive arthroscopic ACL reconstructions were performed at our institution (5,907 primary and 1,189 revision reconstructions). Thereof, cases with postoperative septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical presentation, time to and number of arthroscopic revisions, clinical course and microbiological findings. Follow-up examination consisted of clinical examination, instrumental measurement (KT-1000), classification according to objective IKDC (International Knee Documentation Committee) score, subjective IKDC score and radiologic evaluation. RESULTS: The incidence of septic arthritis was 0.51%, with 0.41% in primary and 1.01% in revision reconstructions, respectively (p = 0.008; odds ratio 2.5). First revision was performed 19.6 ? 10.6 days after index procedure. Eradication was achieved in all cases after an average of 2.25 ? 1.22 arthroscopic revisions, with graft retainment in all but one case (97.2%). Coagulase-negative Staphylococci (62.5%) and Staphylococcus aureus (21.9%) were the most frequent pathogens. Twenty-nine patients were available for follow-up (80.6%) after 4.7 ? 3.2 years (range 0.7 to 11.2). No reinfection was seen. Two patients suffered recurrent non-traumatic ACL insufficiency (6.9%), all others (93.1%) had an intact ACL graft with a KT-1000 side-to-side difference of 1.4 ? 0.9mm. Subjective IKDC score was 80.4 ? 11 points. No emerging or deterioration of osteoarthritis related to the infection was seen. CONCLUSION: Postoperative septic arthritis is a rare but serious complication after arthroscopic ACL reconstruction. Retention of the graft and good to excellent clinical results can be obtained with an arthroscopic treatment protocol.