Download PDF
J Knee Surg 2019; 32(11): 1111-1120
DOI: 10.1055/s-0038-1675794
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

Robin Otchwemah
1   Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
2   Institute for Hygiene, Clinics Cologne, Cologne-Merheim Medical Center, Köln, Germany
,
Jan-Hendrik Naendrup
1   Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
,
Frauke Mattner
2   Institute for Hygiene, Clinics Cologne, Cologne-Merheim Medical Center, Köln, Germany
,
Thorsten Tjardes
1   Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
,
Holger Bäthis
1   Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
,
Sven Shafizadeh
1   Department of Trauma Surgery and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, Köln, Germany
› Author Affiliations
Further Information

Publication History

22 February 2017

29 September 2018

Publication Date:
26 November 2018 (online)

   Permissions and Reprints

Abstract

Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ±  9.9) years and admitted 14 ( ±  7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

Keywords

anterior cruciate ligament reconstruction - infection - joint - arthritis - staphylococcus
 

  • References

  • 1 Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (04) 375-384
    CrossrefPubMedGoogle Scholar
  • 2 Scully WF, Fisher SG, Parada SA, Arrington ED. Septic arthritis following anterior cruciate ligament reconstruction: a comprehensive review of the literature. J Surg Orthop Adv 2013; 22 (02) 127-133
    CrossrefPubMedGoogle Scholar
  • 3 Williams III RJ, 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 (02) 261-267
    CrossrefPubMedGoogle Scholar
  • 4 Fong SY, Tan JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore 2004; 33 (02) 228-234
    PubMedGoogle Scholar
  • 5 Parada SA, Grassbaugh JA, Devine JG, Arrington ED. Instrumentation-specific infection after anterior cruciate ligament reconstruction. Sports Health 2009; 1 (06) 481-485
    CrossrefPubMedGoogle Scholar
  • 6 Schollin-Borg M, Michaëlsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 2003; 19 (09) 941-947
    CrossrefPubMedGoogle Scholar
  • 7 Kim S-J, Postigo R, Koo S, Kim JH. Infection after arthroscopic anterior cruciate ligament reconstruction. Orthopedics 2014; 37 (07) 477-484
    CrossrefPubMedGoogle Scholar
  • 8 Stutz G, Gächter A. Diagnostik und stadiengerechte Therapie von Gelenkinfekten. Unfallchirurg 2001; 104 (08) 682-686
    CrossrefPubMedGoogle Scholar
  • 9 Centers for Disease Control and Prevention. CDC/NHSN Surveillance Definitions for Specific Types of Infections. Available at: https://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf
    PubMed
  • 10 Kuršumović K, Charalambous CP. Graft salvage following infected anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Bone Joint J 2016; 98-B (05) 608-615
    CrossrefPubMedGoogle Scholar
  • 11 Calvisi V, Lupparelli S. C-reactive protein changes in the uncomplicated course of arthroscopic anterior cruciate ligament reconstruction. Int J Immunopathol Pharmacol 2008; 21 (03) 603-607
    CrossrefPubMedGoogle Scholar
  • 12 Mouzopoulos G, Fotopoulos VC, Tzurbakis M. Septic knee arthritis following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1033-1042
    CrossrefPubMedGoogle Scholar
  • 13 Wang C, Ao Y, Fan X. , et al. changes after arthroscopic anterior cruciate ligament postoperative infection. Arthrosc J Arthrosc Relat Surg 2014; 30 (09) 1110-1115
    PubMedGoogle Scholar
  • 14 Wang C, Ao Y, Fan X. , et al. C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection. Arthrosc J Arthrosc. Relat Surg 2014; 30 (09) 1110-1115
    PubMedGoogle Scholar
  • 15 Trampuz A, Piper KE, Jacobson MJ. , et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007; 357 (07) 654-663
    CrossrefPubMedGoogle Scholar
  • 16 Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graft-retaining treatment protocol. Am J Sports Med 2015; 43 (12) 3005-3012
    CrossrefPubMedGoogle Scholar
  • 17 Saper M, Stephenson K, Heisey M. Arthroscopic irrigation and debridement in the treatment of septic arthritis after anterior cruciate ligament reconstruction. Arthroscopy 2014; 30 (06) 747-754
    CrossrefPubMedGoogle Scholar
  • 18 Erice A, Neira MI, Vargas-Prada S, Chiaraviglio A, Gutiérrez-Guisado J, Rodríguez de Oya R. Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review. Enferm Infecc Microbiol Clin 2018; 36 (06) 336-341
    CrossrefPubMedGoogle Scholar
  • 19 Bellmann R, Kuchling G, Dehghanyar P. , et al. Tissue pharmacokinetics of levofloxacin in human soft tissue infections. Br J Clin Pharmacol 2004; 57 (05) 563-568
    CrossrefPubMedGoogle Scholar
  • 20 Landersdorfer CB, Bulitta JB, Kinzig M, Holzgrabe U, Sörgel F. Penetration of antibacterials into bone: pharmacokinetic, pharmacodynamic and bioanalytical considerations. Clin Pharmacokinet 2009; 48 (02) 89-124
    CrossrefPubMedGoogle Scholar
  • 21 Joukhadar C, Stass H, Müller-Zellenberg U. , et al. Penetration of moxifloxacin into healthy and inflamed subcutaneous adipose tissues in humans. Antimicrob Agents Chemother 2003; 47 (10) 3099-3103
    CrossrefPubMedGoogle Scholar
  • 22 Goldenberg DL. Septic arthritis. Lancet 1998; 351 (9097): 197-202
    CrossrefPubMedGoogle Scholar
  • 23 Petersen W, Herbort M, Höynck E, Zantop T, Mayr H. Stage-adapted treatment of infection after reconstruction of the anterior cruciate ligament . [in German ]. Oper Orthop Traumatol 2014; 26 (01) 63-74
    CrossrefPubMedGoogle Scholar
  • 24 Calvo R, Figueroa D, Anastasiadis Z. , et al. Septic arthritis in ACL reconstruction surgery with hamstring autografts. Eleven years of experience. Knee 2014; 21 (03) 717-720
    CrossrefPubMedGoogle Scholar
  • 25 Maletis GB, Inacio MCS, Reynolds S, Desmond JL, Maletis MM, Funahashi TT. Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 2013; 41 (08) 1780-1785
    CrossrefPubMedGoogle Scholar