Skip to main content
SpringerLink
Log in

Recommendations for the management of septic arthritis after ACL reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the current evidence for the management of septic arthritis after anterior cruciate ligament (ACL) reconstruction, the factors that affect the outcome after treatment and the retention of graft and implants.

Methods

A systematic literature search of the PubMed database was performed on septic arthritis after ACL reconstruction. A total of 301 publications were initially identified, and 17 papers were found to fulfil the criteria to be included in the review.

Results

There were 196 cases of septic arthritis after ACL reconstruction in over 30,000 ACL reconstructions, making the proportion of infection 0.6 %. Most patients (114/123, 92.6 %) had an acute or subacute infection at an average of 16.8 ± 10.5 days after ACL reconstruction. Coagulase-negative Staphylococci (CNS) was the most common organism (67/147, 45.6 %) followed by Staphylococcus aureus (SA) (35/147, 23.8 %); 86.9 % underwent surgical treatment of which 92.8 % had an average of 1.54 (up to 4) arthroscopic debridements. The group with SA infection had a higher graft removal rate (33.3 %, p = 0.019), a longer antibiotic duration (35.4 days, p = 0.047) and a worse range of flexion (111.5°, p = 0.036) than the CNS group.

Conclusions

CNS was the most common organism in septic arthritis after ACL reconstruction followed by SA. For most authors, arthroscopic debridement combined with intravenous antibiotic therapy was the initial treatment of choice. Antibiotic therapy with or without multiple irrigations of the joint is not recommended based on the high failure rates. Delayed diagnosis of more than 7 days or SA infection required a longer duration of antibiotic therapy and increased the likelihood for graft removal and restricted range of motion. Fungal infection and tubercular infection had a high prevalence of late diagnosis and open debridement.

Level of evidence

Systematic review, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Archer GL (1998) Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis 26(5):1179–1181

    Article  CAS  PubMed  Google Scholar 

  2. Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P (2007) Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 15(4):387–392

    Article  PubMed  Google Scholar 

  3. Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ III, Allen AA (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38(2):281–286

    Article  PubMed  Google Scholar 

  4. Benner RW, Shelbourne KD, Freeman H (2011) Infections and patellar tendon ruptures after anterior cruciate ligament reconstruction: a comparison of ipsilateral and contralateral patellar tendon autografts. Am J Sports Med 39(3):519–525

    Article  PubMed  Google Scholar 

  5. Burks RT, Friederichs MG, Fink B, Luker MG, West HS, Greis PE (2003) Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med 31(3):414–418

    PubMed  Google Scholar 

  6. Cassat JE, Lee CY, Smeltzer MS (2007) Investigation of biofilm formation in clinical isolates of Staphylococcus aureus. Methods Mol Biol 391:127–144

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  7. Fong SY, Tan JL (2004) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore 33(2):228–234

    CAS  PubMed  Google Scholar 

  8. Gächter A (1993) Arthroscopic lavage for joint infections. Orthop Traumatol 2(2):104–106

    Article  Google Scholar 

  9. Gjertsson I, Innocenti M, Matrisian LM, Tarkowski A (2005) Metalloproteinase-7 contributes to joint destruction in Staphylococcus aureus induced arthritis. Microb Pathog 38(2–3):97–105

    Article  CAS  PubMed  Google Scholar 

  10. Goldenberg DL, Chisholm PL, Rice PA (1983) Experimental models of bacterial arthritis: a microbiologic and histopathologic characterization of the arthritis after the intraarticular injections of Neisseria gonorrhoeae, Staphylococcus aureus, group A streptococci, and Escherichia coli. J Rheumatol 10(1):5–11

    CAS  PubMed  Google Scholar 

  11. Indelli PF, Dillingham M, Fanton G, Schurman DJ (2002) Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 398:182–188

    Article  PubMed  Google Scholar 

  12. Judd D, Bottoni C, Kim D, Burke M, Hooker S (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22(4):375–384

    Article  PubMed  Google Scholar 

  13. Katz LM, Battaglia TC, Patino P, Reichmann W, Hunter DJ, Richmond JC (2008) A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy 24(12):1330–1335

    Article  PubMed  Google Scholar 

  14. Matava MJ, Evans TA, Wright RW, Shively RA (1998) Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors. Arthroscopy 14(7):717–725

    Article  CAS  PubMed  Google Scholar 

  15. Monaco E, Maestri B, Labianca L, Speranza A, Vadalà A, Iorio R, Ferretti A (2010) Clinical and radiological outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. J Orthop Sci 15(2):198–203

    Article  PubMed  Google Scholar 

  16. Muscolo DL, Carbo L, Aponte-Tinao LA, Ayerza MA, Makino A (2009) Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction. Clin Orthop Relat Res 467:2420–2425

    Article  PubMed Central  PubMed  Google Scholar 

  17. Musso AD, McCormack RG (2005) Infection after ACL reconstruction: what happens when cultures are negative? Clin J Sport Med 15(5):381–384

    Article  CAS  PubMed  Google Scholar 

  18. Nag HL, Neogi DS, Nataraj AR, Kumar VA, Yadav CS, Singh U (2009) Tubercular infection after arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 25(2):131–136

    Article  PubMed  Google Scholar 

  19. Schollin-Borg M, Michaelsson K, Rahme H (2003) Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 19(9):941–947

    Article  PubMed  Google Scholar 

  20. Schulz AP, Götze S, Schmidt HG, Jürgens C, Faschingbauer M (2007) Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen. Am J Sports Med 35(7):1064–1069

    Article  PubMed  Google Scholar 

  21. Smith RL, Schurman DJ, Kajiyama G, Mell M, Gilkerson E (1987) The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg Am 69(7):1063–1068

    CAS  PubMed  Google Scholar 

  22. Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8(5):270–274

    Article  CAS  PubMed  Google Scholar 

  23. Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H (2007) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 35(7):1059–1063

    Article  PubMed  Google Scholar 

  24. Viola R, Marzano N, Vianello R (2000) An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy 16(2):173–177

    Article  CAS  PubMed  Google Scholar 

  25. Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J (2009) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 25(3):243–249

    Article  PubMed  Google Scholar 

  26. Williams RJ III, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S (1997) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction diagnosis and management. Am J Sports Med 25(2):261–267

    Article  PubMed  Google Scholar 

  27. Wirtz D, Marth M, Miltner O, Schneider U, Zilkens KW (2001) Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 25(4):239–241

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Zalavras CG, Patzakis MJ, Tibone J, Weisman N, Holtom P (2005) Treatment of persistent infection after anterior cruciate ligament surgery. Clin Orthop Relat Res 439:52–55

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China

    Cheng Wang

  2. Department of Orthopedic Surgery, Changi General Hospital, Singapore, Singapore

    Yee Han Dave Lee

  3. HKF - Center for Hip-Knee-Foot Surgery and Sportstraumatology, ATOS Hospital Heidelberg, Heidelberg, Germany

    Rainer Siebold

  4. Institute for Anatomy and Cell Biology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany

    Rainer Siebold

Authors
  1. Cheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yee Han Dave Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rainer Siebold
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rainer Siebold.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, C., Lee, Y.H.D. & Siebold, R. Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22, 2136–2144 (2014). https://doi.org/10.1007/s00167-013-2648-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-013-2648-z

Keywords

Search

Navigation