Search Filters

  • Presentation Format
  • Media Type
  • Diagnosis / Condition
  • Diagnosis Method
  • Patient Populations
  • Treatment / Technique

Increased Osteoarthritis And Knee Instability Following Postoperative Septic Knee Arthritis After Anterior Cruciate Ligament Reconstruction with a Minimum 8 Year Follow-Up


Thomas R. Pfeiffer, Prof.
GERMANY

Increased Osteoarthritis And Knee Instability Following Postoperative Septic Knee Arthritis After Anterior Cruciate Ligament Reconstruction with a Minimum 8 Year Follow-Up

Thomas R. Pfeiffer, Prof., GERMANY Julius Stüber, cand. med., GERMANY Jan-Hendrik Naendrup, BS, MD, GERMANY Daniel Guenther, MD, PD, GERMANY Robin Otchwemah, MD, GERMANY Sven T. Shafizadeh, Prof., GERMANY Paola Kappel, MD, GERMANY Arasch Wafaisade, PD, GERMANY Sebastian Imach, MD, MBA, GERMANY

Cologne Merheim Medical Center - Orthopedic Surgery University Witten/Herdecke, Cologne, GERMANY

2021 Congress   ePoster Presentation     Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Arthritis

Treatment / Technique

Arthroscopy

Ligaments

ACL

Diagnosis Method

X-ray

Sports Medicine

Outcome Studies

This media is available to current ISAKOS Members, Global Link All-Access Subscribers and Webinar/Course Registrants only.
Log inSubscription Options

Summary: Patients with postoperative septic knee arthritis following ACL reconstruction develop significantly more osteoarthritis, increased knee joint instability, and restricted range of motion even after successful rehabilitation of the infection using a standardized graft retaining protocol compared to a matched noninfected group of ACL-reconstructions in a Minimum 8 year Follow up.

Postoperative septic knee arthritis is a feared complication following anterior cruciate ligament (ACL) reconstruction. In previous studies evaluating short-term and mid-term follow-up, good knee function has been described, however long-term consequences have not been investigated. Therefore, aim of this study was to evaluate knee joint function, activity level, and osteoarthritis development in patients at least 8 years after postoperative septic knee arthritis following ACL reconstruction and to compare this cohort to a matched control group with patients at least 8 years after ACL reconstruction without any signs of postoperative septic knee arthritis.

From October 2010 to January 2012, 31 patients in our institution were treated with septic knee arthritis following ACL reconstruction with graft-retaining treatment protocols, consisting of sequential arthroscopic lavages and systemic anti-infective treatment. Follow-up examinations after a minimum of 8 years included clinical examination, measurement of anterior translation (Rolimeter), classification according to IKDC, WOMAC, and Tegner-Score. Progression of osteoarthritis was described in radiographs using Kellgren-Lawrence-Score. Aspiration of synovial fluid was performed in patients with signs of persistent infection. Aspirated synovial fluid was evaluated macroscopically, microbiologically, and by multiplex PCR. Based gender, age, BMI, concomitant injuries, ACL Graft and preoperative Tegner Score, a matched healthy control group was assembled and examined in the same manner.

Until abstract deadline, 18 patients with septic knee arthritis (58%) could be included after a mean follow-up period of 8.6yr [8.0-9.8]. The control group included 16 patients (FU 10.0yr, [9.7-10.3]). There were no significant differences regarding all matching criteria.
The Infection group had significantly higher side-to-side differences regarding Lachman Test compared to the control group (2,9 mm ± 1.6 mm vs. 0.9 mm ±3.0mm; p=0,047). In the Infection Group, a significantly higher number of patients with extension deficite (7.5° ± 4,7°) (p=0,047) was noted. In both groups the mean Tegner-Score of 6.7 [3-10] and 6,3 [3-10], was significantly reduced (p <0,05) compared to the preoperative Score, however no significant difference in degree of reduction was noted (-2,1 (± 2,7) vs. -1,1 (±1,9) p=0,218). At =8 years follow up there was no significant difference regarding IKDC (p=0,409) and WOMAC-Score (p=0,621). The IKDC-Score in the infection group and the control group were 75,7 ± 17.2 and 80,4 (±15.2), respectively. A significantly higher grade of osteoarthritis was found in the infection group (1,75 ±0,8) compared to the control group(0.5±1.5) (p=0,021).
In three patients (16%), there were clinical signs of persistent knee infection. Neither the microbiological examination nor the PCR of the joint puncture revealed persistent septic knee arthritis in any of these patients. There was no association between subjective and objective outcome and initial pathogen nor Gächter stage. Only the number of lavages correlated with the degree of long-term knee instability (R=0,56; p=0,04).

Patients with postoperative septic knee arthritis following ACL reconstruction develop significantly more osteoarthritis, increased knee joint instability, and restricted range of motion even after successful rehabilitation of the infection and graft preservation compared to a matched noninfected group. This development is independent of the severity of the infection and the germ spectrum, causing it.

More 2021 Congress ACL Abstract Presentations

More ISAKOS 2021: Global Content