Kuzyk PR et al. 2014;30(6):747-54. Return to any sporting activities after ACL reconstruction occurs in 80% of cases and return to the same level of activity is experienced by 65% of patients.41 Makhni et al.,22 in a recent meta-analysis, reported a 67% return to sports, 13% knee instability, and a median score of 82.1 in the Lysholm Knee Scoring System after infection following ACL reconstruction.22 Windhamre et al.,38 in a recent study, demonstrated that all patients achieved an improvement over their functional score before reconstruction; however, they tended to have lower functional outcomes to similar groups that were not infected.38, In cases of graft removal, ACL revision, in which a new reconstruction of the ACL occurs, is a treatment option. On the other hand, in cases like the one reported in this review, in which factors of bad prognosis are present, the authors recommend removal of synthetic material, such as a screw, and graft removal. This case illustrates that post-operative Mycobacterium infection can occur as a complication of ACL reconstruction with bioabsorbable screw fixation and should be considered in the differential diagnosis of post-operative periprosthetic infection. 2007 Aug;23(8):911.e1-4. The authors have declared no conflicts of interest. Viola et al.35 proposed only antibiotics; meanwhile, Monaco et al.36 proposed antibiotics and joint irrigation. 2017;2017:1-3. 2000;16(2):173-7. The CRP and ESR values were 175 mg/L and 50 mm/hour, respectively, values that are above the cut-off values described by Wang et al.30. Managing septic arthritis after knee ligament reconstruction. Figure 3: C-reactive protein (mg/L) and erythrocyte sedimentation rate (mm/hour) behaviour from Day 1–16 of treatment. After 10 days of IV treatment, the patient achieved a normal CRP of 18 mg/L and was discharged with cefadroxil 1 g every 12 hours until 6 weeks of treatment were complete. patella fracture (usually postop during rehab), patellar tendon rupture. Knee Surg Sports Traumatol Arthrosc. Fundamentals in rotator cuff repair and reconstruction from world-renowned experts! Early diagnosis of complications is vital to improve functional outcome. The authors use cephalosporin as empirical treatment and adjust by culture results and antibiogram. They performed revision with an ipsilateral BTB autograft after 5–9 months of treatment in 4 of 6 patients. Prevention and treatment information (HHS). Postoperative septic arthritis after anterior cruciate ligament reconstruction: Does it affect the outcome? Orthopedics. The patient reported in this case had many factors of a bad prognosis: infection with S. aureus, chronic presentation, and substantial joint damage, so immediately the graft and screws were removed. 2017;2017. After 2 days of treatment, the patient recovered 50° of knee range of motion (-20° extension and 70° flexion), and his pain decreased considerably. Complications of Bioabsorbable Tibial Interference Screws After Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Athletes. Joints. Alomar AZ et al. Ankylosis of the knee after septic arthritis following anterior cruciate ligament reconstruction in a 13-year-old male. 2016;4(3):1-23. J Knee Surg. Arthrex offers a comprehensive selection of soft-tissue fixation devices for a variety of techniques. This article presents a case of infection after ACL reconstruction and discusses risk factors, treatment choice, antibiotic treatment length, and functional outcomes, proposing a guide for the treatment. The recommended method is to use gentamicin or 2% chlorhexidine, achieving negative cultures of approximately 100%. Kramer DE, Kalish LA, Kocher MS, Yen YM, Micheli LJ, Heyworth BE. Makhni EC et al. Koga H et al. In the medial and lateral compartment, an important loss of meniscal tissue and extensive and diffuse Grade 3 International Cartilage Research Society (ICRS) classification chondral damage in both condyles and tibial plateaus was observed (Figure 2). Extra-articular extraosseous migration of a bioabsorbable femoral interference screw after ACL reconstruction. ), Rehabilitation for the Postsurgical Orthopedic Patient (2013), St Louis: Mosby, pp.404-26. 2017;29(1):45-51. Plante MJ et al. To our knowledge, this is the first case report of a non-tuberculous mycobacterial infection associated with a bioabsorbable implant. After surgery, he did not recover normal articular range and had intermittent severe pain. Krutsch W et al. Revision anterior cruciate ligament reconstruction. Two-step revision firstly requires the filling of the tunnels with a bone graft, then waiting 4–6 months for graft incorporation, and in the second procedure, ACL reconstruction is carried out.43. Please note that certain bio (PLLA) anchors and screws are not available for sale in EMEA. Alomar et al.25 performed a case-control study in which they took cultures of a dropped graft (case) and a graft that was always kept on the surgical table (control). Infection following anterior cruciate ligament (ACL) surgery is an uncommon but serious complication. I created this video with the YouTube Video Editor (https://www.youtube.com/editor) Epub 2006 Nov 27. In the case presented, the authors were even more prompt with the indication of the second procedure, given that it was a chronic presentation that caused much joint damage and had extensive fibrotic tissue. Murphy MV et al. Arthroscopy. Primary meningococcal Type C arthritis: A case report and literature review. Antkowiak Tt et al. When arthroscopic irrigation and debridement and antibiotics are used for treatment, no difference in treatment success exists between autografts (bone-patellar tendon, CT, or HT). Yu A et al. J Bone Joint Surg Am. Martinek and Friederich reported the first case of local inflammatory reaction to a bioabsorbable interference screw after ACL reconstruction in 1999. Bioabsorbable interference screws are usually inert but can initiate a tissue reaction. 2018;46(4):846-51. Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Viola R et al. Therefore, the authors recommend a prompt and comprehensive diagnosis before any suspicion of infection. J Bone Joint Surg Am. Anterior cruciate ligament (ACL) reconstruction complication rate is low, with septic arthritis one of the most frequently seen. 2011 Mar 16;93(6):572-80. doi: 10.2106/JBJS.J.00269. Accessibility There may be drainage from the surgical incisions. 2011;93(e124):1-6. Notably, the control group showed epidemiology more likely to be an ACL reconstruction infection than the control group.25. Arthroscopy. The treatment of an ACL surgery infection includes repeat arthroscopic surgeries to clean out infected areas, and … Treatment success is defined as the eradication of the infection without the need to remove the ACL graft. Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License. During the past 3 decades, graft reconstruction of the anterior cruciate ligament (ACL) has become an accepted treatment for symptomatic ACL deficiency. Case Rep Orthop. After taking cultures, 2 g of cefazolin every 8 hours was started. We'll assume you're ok with this, but you can opt-out if you wish. Many variables have been studied to determine if they are a risk factor for infection after ACL reconstruction. The graft was completely loose, the femoral tunnel was widened, and the screw was removed with a grasper clamp, without the help of a screwdriver, and purulent exudate surrounded it. A retrospective controlled study. Psoriatic arthritis (PsA) is an inflammatory condition of the joints and the areas where tendons and ligaments connect with bone…, Knee Infection After Anterior Cruciate Ligament Reconstruction. 2014;37(7):477-84. Copyright © 2021 European Medical Group LTD trading as European Medical Journal. Recommendations for the management of septic arthritis after ACL reconstruction. 2018;46(6):1500-8. ), Revision ACL Reconstruction (2014), Springer: New York, NY, pp.1-273. Wang C et al. Arthroscopy. Hantes ME et al. There are no established guidelines for allografts.12,23,24, In addition to accidental contamination, such as incidence of the graft falling to the ground, there is concern about the contamination of the graft as it was placed on the surgical table. After the second arthroscopy irrigation and debridement, the patient’s condition improved, achieving a joint range of -10° extension and 80° flexion, and considerably less pain. The presentation can be as late as 2–3 years postoperatively and may mimic an infection. 2017;30(6): 535-43. Torres-Claramunt R et al. On the other hand, Pérez-Prieto et al.40 proposed an oral treatment with levofloxacin and rifampicin as soon as cultures are available, a treatment which should be continued for 6–8 weeks, with no more than 3–4 days of IV treatment. 2013;21(3): 696-701. 2020 Feb 26;8(2):2325967120904010. doi: 10.1177/2325967120904010. Periprosthetic infection is a complication that follows arthroplasty and the incidence varies between 0.4% and 2.0%, while arthroscopic procedures have an incidence that varies between 0.001% and 1.100%.2,3, The anterior cruciate ligament (ACL) is an intra-articular and intrasynovial structure of the knee, which plays a crucial role in joint stability.4 ACL tear incidence is increasing; the most frequent mechanism of ACL tear is an indirect, involuntary torsion known as pivot shift, which consists of a valgus and internal force applied to a knee at a flexion degree of 10–20°.5 General consensus is that anatomical ACL reconstruction can restore anteroposterior and rotatory stability,6 but graft choice depends on different factors, with the most important being the surgeon’s preference and patient’s preference, patient activity, and history of prior surgery.7 The most commonly used grafts are bone-patellar tendon, hamstrings (HT), bone-quadricipital tendon, and allograft.8 Although rare, ACL reconstruction has complications. 2010;15(2):198-203. Horng Lii Oh Sydney Knee Specialists, Suite 211, 203-233 New South Head Road, Edgecliff, NSW 2027, Australia. 2017;63(2): 121-5. Lessons learnt from an atypical mycobacterium infection post-anterior cruciate ligament reconstruction. Knee X-rays and laboratory tests were performed; the X-rays showed osteolysis around the femoral metallic screw and loss of the definition of the distal edge of femur, especially in the lateral condyle (Figure 1), confirming that the infection was not acute. Both procedures were performed in other institutions. Infection following anterior cruciate ligament reconstruction: An analysis of 6,389 cases. Chondrolysis of the tibial plateau caused by articular. The most frequent infection-causing agents were the Staphylococci, with the most common, S. epidermis, responsible for 50% of incidences (coagulase-negative staphylococcus [CNS]), followed by S. aureus. Complications in brief: Anterior cruciate ligament reconstruction. The most common symptoms of infection following ACL reconstruction are fever, knee effusion, loss of knee flexion, and pain. 2014;22(3):153-64. J Orthop Traumatol. Figure 1: X-rays of the damaged knee joint taken at the emergency department. The degradation of PLC screws does not follow the gradual and controlled pattern demonstrated in the ovine model. It is important to recognise inflammatory back pain (IBP) for early diagnosis of ankylosing spondylitis (AS). Infection after arthroscopic anterior cruciate ligament reconstruction. The ISO 9001 standard is an internationally recognised standard that is based on a number of quality management principles including a strong customer focus, the management of process change, effective methods of reducing non- compliance, and the continual improvement in the quality of our services. Cvetanovich GL et al. For now, there are no plans to carry out an ACL revision on this patient. 2017;103(4):619-22. Diagnosis is often delayed as routine microbiological cultures do not utilise specific culture requirements for mycobacterial growth. ), ACL Injury and Its Treatment (2006), Springer: Tokyo, pp.1-562. Copyright 2009 Elsevier B.V. All rights reserved. A 9 millimetre rather than a 7 millimetre screw is advised. Management of the contaminated anterior cruciate ligament graft. doi: 10.1016/j.arthro.2006.07.025. Six months after surgery, the patient resumed his work activities (desk work), had no complaints of instability in daily life activities, had normal CPR and ESR levels, and had a full range of motion. Emond CE, Woelber EB, Kurd SK, Ciccotti MG, Cohen SB. The duration of IV antibiotic administration and total length of antibiotic treatment are topics of debate, and the authors strongly recommend that antibiotics are used until the CRP is <20 mg/dL. Hospital discharge was on Day 11. 2013;37(2):181-6. Among the risk factors for infection reported in the literature, the most consistent is the use of HT graft. This was recognised as a classic presentation of joint infection and it was probably a chronic presentation due to the time elapsed since surgery and beginning of the symptoms. A 50% decrease in CRP value must be expected after 48 hours of treatment and normal values must be reached between 10 and 14 days.30, Some authors suggest no surgical treatment. Saper M et al. Osteolysis around the femoral screw and loss of the definition of the articular edge of the femur, more significant in the lateral condyle, were the most notable findings. Hamstring autografts are associated with a high rate of contamination in anterior cruciate ligament reconstruction. Busfield and Anderson reported in 2007 on two cases of sterile pretibial abscesses with minimal osteolysis at 3 years and 18 months after ACL reconstruction with PLLA interference screws. ... bioabsorbable screws) were introduced. Int Orthop. Risk factors for a worse outcome after ACL reconstruction infection are allograft compared to autograft and S. aureus or polymicrobial infection compared to coagulase-negative staphylococcus infection. 2014;30(9):1110-5. Pérez-Prieto D et al. If the graft must be removed, ACL revision requires no signs of infection for at least 1 month after having completed antibiotic treatment. 8600 Rockville Pike Arthroscopic irrigation and debridement in the treatment of septic arthritis after anterior cruciate ligament reconstruction. As a consequence, a second arthroscopy irrigation and debridement was performed. Knee infection is a challenging scenario. Scrivens B, Kluczynski MA, Fineberg MS, Bisson LJ. The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee and is regarded as the most critical stabilizer. 2010 Mar;11(1):51-5. doi: 10.1007/s10195-009-0079-x. Am J Sports Med. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Factors associated with infection following anterior cruciate ligament reconstruction. Infect Control Hosp Epidemiol. Infection after ACL reconstruction surgery is a rare complication. Referring to the aforementioned case study, except for age (40 years), the patient did not present other risk factors for infection. Stucken C, Garras DN, Shaner JL, Cohen SB. 2018;26(5):1357-61. The tools (e.g., screwdriver) used to insert the screws that hold the graft in place could be an external (environmental) source of contamination. ACL reconstruction is a widely accepted treatment for patients who have instability symptoms from ACL deficiency and desire to resume activity. However, the local temperature still increased, and inflammatory parameters remained unchanged (Figure 3). Uncommon Complications after Anterior Cruciate Ligament Reconstruction. Anderson MJ et al. Advanced design and materials allow surgeons to achieve strong, less invasive anatomic ACL reconstructions with soft-tissue grafts. In both groups, Staphylococcus epidermidis was the most commonly found bacteria, followed by S. aureus in the control group and by Bacillus species in the case group. His inflammatory parameters continued to decrease (CPR 8 mg/L and ESR 17 mm/hour) (Figure 3). FOIA Chambat P et al. 1  The anterior cruciate ligament, or ACL, is … Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: A retrospective analysis of incidence, presentation, treatment, and cause. Epub 2015 Feb 10. Injury of anterior cruciate ligament (ACL) is one of the most common events in sports medicine.1 Computed Tomography Imaging of BioComposite Interference Screw After ACL Reconstruction With Bone-Patellar Tendon-Bone Graft. Infection compromises functional outcome; however, if treatment is started early, good functional results and a return to sports activities can be achieved. Arthroscopy. The screw is placed in a superior position using a guide wire. Knee Surgery, Sport Traumatol Arthrosc. CRP: C-reactive protein; ESR: erythrocyte sedimentation rate. Evaluation of infection after anterior cruciate ligament reconstruction during a short period. Am J Sports Med. Case report managing an acute and chronic periprosthetic infection. ACL: anterior cruciate ligament; PCL: posterior cruciate ligament. Brophy RH et al. only included acute cases, and reported a normalised ESR and CRP after 3 weeks of oral treatment plus surgery. M. fortuitum is a known but rare cause of periprosthetic infection. All rights reserved. Sports‑specific differences in postsurgical infections after arthroscopically assisted anterior cruciate ligament reconstruction. Privacy, Help The ACL stretches from the anterior aspect of the intercondyloid fossa of the tibia just medial and posterior to the anterior tibial spine in a superior, His clinical record showed a left knee ACL reconstruction with bone-patellar tendon-bone (BTB) graft 4 months prior to emergency department admission. Case Rep Orthop. If the symptoms persist or the inflammatory parameters remain stagnant using the correct antibiotic according to antibiogram, a second surgical procedure is performed as soon as possible. The infectious process, if not controlled adequately, will jeopardize the integrity of the articular cartilage and may lead to irreversible damage of the knee joint. A systematic summary of systematic reviews on the topic of the anterior cruciate ligament. Busam ML et al. Orthop J Sports Med. Diabetes and previous ipsilateral knee surgery were not statistically significant variables.14 Despite this finding, a study by the MOON Knee Group showed a higher incidence of infection in diabetic patients following ACL reconstruction.15 Krutsch et al.16 compared infection rate by sport and found that football had a higher rate of infection than skiing, suggesting that ambient temperature must affect infection rates.16 In addition, Westermann et al.17 performed a multivariate analysis in a cohort of 6,389 ACL reconstruction patients comparing infection rates between outpatients and hospital-admitted patients. In this study, we present an unusual case of recurrent infection of the knee after an ACL reconstruction, and discuss the importance of accurate diagnosis and appropriate management, including the issue of graft preservation versus removal. Other reported risk factors are age >20 years, diabetes, and the use of immunosuppressive drugs. Infections in anterior cruciate ligament reconstruction. Arthroscopy. We report two cases of bioabsorbable screw extrusion and Pseudomonas aeruginosa tibial tunnel infection in 17/18-year-old men, 2 and 4 years after ACL … Treatment success is defined as the eradication of the infection without the need to remove the ACL graft. The anterior cruciate ligament (ACL) is a knee ligament that functions to stabilise the knee. Arthroscopy showed extensive compartmentalisation of the knee due to fibrous tissue and a rotten and loose graft. The first author acknowledges Leonel Barahona for his support in writing this article. Barahona M et al. Studies estimate the chance of developing a joint infection (called a septic joint) after an ACL reconstruction surgery are less than 1 percent (0.3 percent in the largest study). Risk factors for surgical site infections following anterior cruciate ligament reconstruction. One way to classify the infection would be as spontaneous or post-surgery, the latter having a particular relevance given the presence of synthetic materials such as screws or prostheses surrounding the joint. Arthroscopic irrigation and debridement, graft retain, and antibiotic therapy are the treatments of choice, reaching a success rate of 85%.33 Graft debridement is only encouraged if a loss of tension is found during arthroscopy procedure, if purulent exudation has adhered to the graft, or in cases of persistent infection after 2–3 arthroscopic irrigation and debridement.34 Treatment must be monitored clinically and using laboratory examinations. Bioabsorbable screws have become a common alternative for interference fixation during ACL reconstruction. The ACL extends from the posterior part of the medial aspect of the femoral condyle to the anteromedial tibial plateau. This site needs JavaScript to work properly. Westermann R et al. Orthop J Sport Med. Am J Sports Med. J Knee Surg. Orthop Traumatol Surg Res. The need for a second surgical procedure depends on the evolution of symptoms; if fever, knee effusion, or decreased range of motion persist or laboratory exam results do not improve within 48–72 hours of treatment, the patient must undergo another surgical procedure.38,39 When the decision to perform graft debridement is made, all screws or other devices must be removed because keeping sutures or such devices can maintain symptoms even after graft removal.39, The duration of intravenous (IV) antibiotic administration and the total length of antibiotic treatment are topics of debate. inserts screws between the tunnel wall and graft to hold the graft in place. 2015 Mar;7(1):135-9. doi: 10.4055/cios.2015.7.1.135. If this happens, there are protocols for treating the contaminated graft, which include the use of gentamicin and chlorhexidine, obtaining negative cultures of >90%.22 The current consensus in cases of contamination, regardless of the type of autograft (BTB or HT), is to perform a washing procedure with saline solution and an antibiotic or disinfectant for 8 minutes. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2014;42(2):292-6. Bethesda, MD 20894, Copyright Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: Techniques, controversies, and outcomes. The dropped graft showed a trend towards more positive cultures; nevertheless, no significant difference was achieved. Postoperative reaction and infection after anterior cruciate ligament (ACL) reconstruction is a rare complication. Several days later, she was switched to Zeniquin – to treat a Staph infection. Orthop J Sports Med. The purpose of this study was not to identify risk factors for infection after ACL reconstruction. 2014;30(9):1100-9. Your body cannot effectively fight infection on the graft, and sometimes the graft needs to be removed in order to cure the infection. Cvetanovich et al.9 reviewed the complications of ACL reconstruction in the first 30 days and found the major complication rate to be 0.55%, with deep vein thrombosis the most frequent; pulmonary embolism and infection were also observed.9 Other studies report similar complication rates and show that infection is one of the most frequent complications after ACL reconstruction, with an incidence between 0.14% and 1.70%.10-13. The aims of this study were to develop…. Khan M et al.