El-Kady RAEH, ElGuindy AMF. Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital.
Infect Drug Resist 2022;
15:3779-3789. [PMID:
35859912 PMCID:
PMC9289172 DOI:
10.2147/idr.s369240]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Septic arthritis (SA) of the knee following anterior cruciate ligament reconstruction (ACLR) is considered a catastrophic complication in terms of reduced or loss function of the involved joint. The aims of this study were to gauge the incidence, risk factors, and causative organisms of SA after ACLR.
Methods
We conducted a retrospective review of 836 patients who underwent primary ACLR at our institution from October 2018 to September 2021. Patients’ demographics, onset of presentation, clinical symptoms, laboratory findings, and management details were obtained from patients’ electronic medical records.
Results
Out of the 836 primary ACLRs, 12 were complicated with SA (1.43%). Independent risk factors associated with SA included age (OR; 11.12, 95% CI; 1.3–94.97), obesity (OR; 8.51, 95% CI; 1.02–71.13), and diabetes mellitus (OR; 12.58, 95% CI; 2.39–66.3). Staphylococcus aureus was the most frequent culprit organism (66.7%), followed by Streptococcus species (25%), and Pseudomonas aeruginosa (8.3%). No fungal, mycobacterial, or polymicrobial growth were recovered from synovial fluid cultures. All of the infected cases underwent arthroscopic joint lavage and debridement in the operating room followed by intravenous antibiotics. Graft removal was not done in any of the involved patients, with eradication of infection in all cases.
Conclusion
SA after ACLR is uncommon, with S. aureus identified in about two-thirds of the patients. Prompt diagnosis and treatment are crucial to avoid graft loss and arthritis-associated joint damage. Orthopedic surgeons should consider rigorous implementation of infection control strategies to minimize the incidence of this devastating morbidity.
Collapse