Infections in anterior cruciate ligament reconstruction

Charlton Stucken, David N Garras, Julie L Shaner, Steven B Cohen, Charlton Stucken, David N Garras, Julie L Shaner, Steven B Cohen

Abstract

Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome.

Evidence acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters.

Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates.

Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis.

Keywords: anterior cruciate ligament; graft type; infection.

Conflict of interest statement

The following authors declared potential conflicts of interest: Steven B. Cohen, MD, is a consultant for Knee Creations Inc. and Smith & Nephew Endoscopy, and also received grants from Major League Baseball and Arthrex, Inc.

References

    1. Armstrong RW, Bolding F. Septic arthritis after arthroscopy: the contributing roles of intra-articular steroids and environmental factors. Am J Infect Control. 1994;22:16-18
    1. Armstrong RW, Bolding F, Joseph R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy. 1992;8:213-223
    1. Azar FM, Arthur ST. Complications of anterior cruciate ligament reconstruction. Tech Knee Surg. 2004;3:238-250
    1. Babcock HM, Carroll C, Matava M, L’ecuyer P, Praser V. Surgical site infections after arthroscopy: outbreak investigation and case control study. Arthroscopy. 2003;19:172-181
    1. Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ, III, Allen AA. Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med. 2010;38:281-286
    1. Barrett GR, Field LD. Comparison of patella tendon versus patella tendon/Kennedy ligament augmentation device for anterior cruciate ligament reconstruction: study of results, morbidity and complications. Arthroscopy. 1993;9:624-632
    1. Berg EE. Tibial bone plug nonunion: a cause of anterior cruciate ligament reconstructive failure. Arthroscopy. 1992;8:380-384
    1. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751-1767
    1. Binnet MS, Basarir K. Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques. Arthroscopy. 2007;23:862-868
    1. Boyce T, Edwards J, Scarborough N. Allograft bone. The influence of processing on safety and performance. Orthop Clin North Am. 1999;30:571-581
    1. Brown CH, Carson EW. Revision anterior cruciate ligament surgery. Clin Sports Med. 1999;18:109-171
    1. Buck BE, Resnick L, Shah SM, Malinin TI. Human immunodeficiency virus cultured from bone. Implications for transplantation. Clin Orthop Relat Res. 1990;251:249-253
    1. Burks R, Friederichs M, Fink B, Luker M, West H, Greis P. Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med. 2003;31:414-418
    1. Centeno JM, Woolf S, Reid JB, Lubowitz JH. Do anterior cruciate ligament allograft culture results correlate with clinical infections? Arthroscopy. 2007;23:1100-1103
    1. Centers for Disease Control and Prevention Hepatitis C virus transmission from an antibody-negative organ and tissue donor—United States, 2000-2002. MMWR Morb Mortal Wkly Rep. 2003;52:273-274, 276
    1. Centers for Disease Control and Prevention Septic arthritis following anterior cruciate ligament reconstruction using tendon allografts—Florida and Louisiana, 2000. MMWR Morb Mortal Wkly Rep. 2001;50:1081-1083
    1. Centers for Disease Control and Prevention Update: allograft associated bacterial infection—United States 2002. MMWR Morb Mortal Wkly Rep. 2002;51:207-210
    1. Clancy WG, Nelson DA, Reider B, et al. Anterior cruciate ligament reconstruction using one-third of the patellar ligament augmented by extra-articular tendon transfers. J Bone Joint Surg Am. 1982;64:352-359
    1. Cohen SB, Sekiya JK. Allograft safety in anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26:597-605
    1. Conrad EU, Gretch DR, Obermeyer KR, et al. Transmission of the hepatitis-C virus by tissue transplantation. J Bone Joint Surg. 1995;77A:214-224
    1. Crawford C, Kainer M, Jernigan D, et al. Investigation of postoperative allograft-associated infection in patients who underwent musculoskeletal allograft implantation. Clin Infect Dis. 2005;41:195-200
    1. Diaz-de-Rada P, Barriga A, Barrosos JL, Garcia-Barrecheguren E, Alfanso M, Valenti JR. Positive cultures in allograft ACL-reconstruction: what to do? Knee Surg Sports Traumatol Arthrosc. 2003;11:219-222
    1. Fong SY, Tan JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore. 2004;33:228-234
    1. Garras DN, Shaner J, Lawson K, Cohen SB. Comparison of infection rates in allograft versus autograft ACL reconstructions. E-poster presented at: Annual Meeting of the Arthroscopy Association of North America; May 2012; Orlando, Florida
    1. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrorsis. Sports Med. 1999;27:143-156
    1. Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2010;92:2402-2408
    1. Guelich DR, Lowe WR, Wilson B. The routine culture of allograft tissue in anterior cruciate ligament reconstruction. Am J Sports Med. 2007;35:1495-1499
    1. Harner CD, Giffin JR, Dunteman RC, et al. Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect. 2001;50:463-474
    1. Harner CD, Irrgang JJ, Paul J, Dearwater S, Ru FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20:499-506
    1. Harner CD, Olson E, Irrgang JJ, et al. Allograft versus autograft anterior cruciate ligament reconstruction: 3-to 5-year outcome. Clin Orthop. 1996;324:134-144
    1. Harner CD, Poehling GG. Double bundle or double trouble? Arthroscopy. 2004;20:1013-1014
    1. Hirshman HP, Daniel DM, Miysaka K. The fate of unoperated knee ligament injuries. In: Daniel DM, Akeson W, O’Connor J, eds. Knee Ligaments: Structure, Function, Injury and Repair. New York: Raven Press; 1990:481-503
    1. Howe JG, Johnson RJ, Kaplan MJ, et al. Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I. Long-term follow-up. Am J Sports Med. 1991;19:447-457
    1. Indelli P, Dillingham M, Fanton G, Schurman D. Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop. 2002;398:182-188
    1. Johnson RJ, Eriksson E, Haggmark T, et al. Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop. 1984;183:122-140
    1. Jones KG. Reconstruction of the anterior cruciate ligament using the central one-third of the patellar ligament. A follow-up report. J Bone Joint Surg Am. 1970;52:1302-1308
    1. Joyce MJ. Safety and FDA regulations for musculoskeletal allografts: perspectives of an orthopaedic surgeon. Clin Orthop. 2005;435:22-30
    1. Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following anterior cruciate ligament reconstruction. Arthroscopy. 2006;22:375-384
    1. Katz LM, Battaglia TC, Patino P, Reichmann W, Hunter DJ, Richmond JC. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy. 2008;24:1330-1335
    1. Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC. Factors involved in the development of osteoarthritis following anterior cruciate ligament surgery. Am J Sports Med. 2010;38:455-463
    1. Kurokouchi K, Takahashi S, Yamada T, Yamamotot H. Methicillin-resistant staphylococcus aureus-induced septic arthritis after anterior cruciate ligament reconstruction. Arthroscopy. 2008;24:615-617
    1. Margheritini F, Camillieri G, Mancini L, Mariani PP. C-reactive protein and erythrocyte sedimentation rate changes following arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2001;9:343-345
    1. Marzo JM, Bowen MK, Warren RF, Wickiewicz TL, Altchek DW. Intra-articular fibrous nodule as a cause of loss of extension following anterior cruciate ligament reconstruction. Arthroscopy. 1992;8:10-18
    1. Matawa MJ, Evans TA, Wright RW, Shively RA. Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors. Arthroscopy. 1998;14:717-725
    1. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J. Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med. 1999;27:562-570
    1. Mei-Dan O, Mann G, Steinbacher G, Ballester SJ, Cugat RB, Alvarez PD. Septic arthritis with Staphylococcus lugdnensis following arthroscopic ACL revision with BPTB allograft. Knee Surg Sports Traumatol Arthrosc. 2008;16:15-18
    1. Montgomery SC, Campbell J. Septic arthritis following arthroscopy and intra-articular steroids. J Bone Joint Surg Br. 1989;71:540.
    1. Muscolo DL, Carbo L, Aponte-Tinao LA, Ayerza MA, Makino A. Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction. Clin Orthop Relat Res. 2009;467:2420-2425
    1. Nag HL, Neogi DS, Nataraj AR, Ajay KV, Yadav CS, Singh U. Tubercular infection after arthroscopic anterior cruciate ligament reconstruction. J Arthrosc Rel Surg. 2009;25:131-136
    1. Noyes FR, Barber S. The effect of an extra-articular procedure on allograft reconstruction for chronic rupture of the anterior cruciate ligament. J Bone Joint Surg Am. 1991;73:882-892
    1. Oh HL, Chen DB, Seeto BG, MacDessi SJ. Mycobacterium fortium infection after anterior cruciate ligament reconstruction using a polylactic acid bioabsorbable screw: case report. Knee 2010;17:176-178
    1. Papakonstantinou O, Chung C, Chanchairujira K, Resnick D. Complications of anterior cruciate ligament reconstruction: MR imaging. Eur Radiol. 2003;13:1106-1117
    1. Pierre PS. Complications of anterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2004;12:185-195
    1. Schollin-Borg M, Michaelsson K, Rahme H. Presentation, outcome and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy. 2003;19:941-947
    1. Schub DL, Schmitz LM, Sakamoto FA, Winalski CS, Parker RD. Long-term outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med. 2012;40:2764-2770
    1. Schulz AP, Gotze S, Schmidt HGK, Jurgens C, Faschingbauer M. Septic arthritis of the knee after anterior cruciate ligament surgery: a stage-adapted treatment regimen. Am J Sports Med. 2007;35:1064-1069
    1. Shelton WR, Treacy SH, Dukes AD, Bomboy AL. Use of allografts in knee reconstruction: I. Basic science aspects and current status. J Am Acad Orthop Surg. 1998;6:165-168
    1. Simonds Holmberg SD, Hurwitz RL, et al. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med. 1992;326:726-732
    1. Smith RL, Schurman DJ, Kajiyama BA, Mell M, Gilkerson E. The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis. J Bone Joint Surg Am. 1987;69:1063-1068
    1. Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J Med. 2008;359:2135-5142
    1. Tomford WW. Transmission of disease through transplantation of musculoskeletal allografts. J Bone Joint Surg Am. 1995;77:1742-1754
    1. Tuman J, Diduch DR, Baumfeld JA, Rubino LJ, Hart JM. Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery. Arthroscopy. 2008;24:618-620
    1. Vallianatos PG, Tilentzogloe AC, Koutsoukou AD. Septic arthritis caused by Erysipelothrixrhusiopathiae infection after arthroscopically assisted anterior cruciate ligament reconstruction. Arthroscopy. 2003;19(3):1-4
    1. Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence management and outcome. Am J Sports Med. 2007;35:1059-1063
    1. Viola R, Marzano N, Vianello R. An unusual epidemic: staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy. 2000;16:173-177
    1. Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy. 2009;25:243-249
    1. Williams RJ, III, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med. 1997;25:261-267
    1. Zalavras CG, Patzakis MJ, Tibone J, Weisman N, Holtom P. Treatment of persistent infection after anterior cruciate ligament surgery. Clin Orthop Relat Res. 2005;439:52-55

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