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Postoperative Septic Arthritis After ACL Reconstruction – Does it Affect the Outcome?


Helena Boström Windhamre, MD
SWEDEN

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Postoperative Septic Arthritis After ACL Reconstruction – Does it Affect the Outcome?

Helena Boström Windhamre, MD, SWEDEN Christina Mikkelsen, PT, SWEDEN Magnus Forssblad, SWEDEN Lotta Willberg, MD, SWEDEN

Stockholm Sports Trauma Research Center , Stockholm, SWEDEN

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Ligaments

Diagnosis / Condition

Instability

Diagnosis Method

Physical Examination X-ray

Sports Medicine

Outcome Studies

Treatment / Technique

Arthroscopy Autograft Repair / Reconstruction

Ligaments

ACL

Summary: Postoperative septic arthritis after ACL reconstruction results in the same functional outcome as uncomplicated cases, patients can be subjectively satisfied and the grafts can be kept!

Purpose

To determine if medium to long-term outcome after septic arthritis following Anterior Cruciate Ligament (ACL) reconstruction is inferior compared to uncomplicated ACL reconstructions.

Methods

During 2001-2009 4384 primary ACL reconstructions were performed at Capio Artro Clinic. All postoperative septic arthritis were retrospectively reviewed. 43 patients met inclusion criteria. 27 patients agreed on re-examination (infected group) and were compared with 27 matched uncomplicated ACL reconstructed patients (control group). Re-examination for both groups included objective and subjective evaluation. The objective evaluation comprised radiographic and physical examination, functional testing, measurement of range of motion (ROM), strength, stability and the questionnaire International Knee Documentation Committee (IKDC). Subjective evaluation consisted of Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner, Lysholm and EQ5D, questions concerning subjective satisfaction, rating of knee function with SANE (Single Assessment Numeric Evaluation) and pain rating with VAS.

Results

Mean follow-up was 60 months for the infected group and 66 months for the control group. There was no significant difference in objective knee function.
In subjective knee function no significant difference was detected in SANE, pain during activity scored with VAS or the KOOS sub-scale symptoms.
The infected group scored significantly inferior in KOOS sub-scales pain 82 versus (vs) 93 (p= .014), ADL 89 vs 98 (p= .008), Sports/Rec 65 vs 82 (p= . 015) and QOL 61 vs 78 (p= .007). Also in Tegner the infected group scored lower, 5,1 vs 6,5 (p= .001) and in EQ5D the infected group scored 0,765 vs 0,909 (p= .004).

Conclusions

Septic arthritis after ACL reconstruction results in the same objective knee function as uncomplicated cases. Infected patients may subjectively experience some degree of inferior knee function but can be as satisfied as non-infected patients. The graft can be kept with thorough arthroscopic lavage and debridement. Repeat arthroscopy if necessary.