The Speed of Pathogen Eradication May Prevent the Early Development of Cartilage Destruction: Case Series of Long-Term Follow-Up of Septic Arthritis (SA) after Anterior Cruciate Ligament Reconstruction (ACL-R) and Literature Review

Abstract

Late diagnosis and treatment of septic arthritis (SA) after anterior cruciate ligament reconstruction (ACL-R) can lead to graft and cartilage damage. Pathogen eradication time may be the key to preventing the development of osteoarthritis. The purpose of this study was to evaluate the effect of the proposed management of SA after ACL-R on knee function, pathogen eradication time and knee cartilage status on MRI. Five patients with acute knee SA after ACL-R were included in this study. All five patients underwent knee arthroscopic debridement with lavage and flow drainage with physiological saline with vancomycin. All five patients underwent clinical assessment, isokinetic examinations and MRI quantitative cartilage thickness evaluation at two follow-up points: at a mean of 10.9 years and at a mean of 18.1 years. Slight statistical differences in cartilage thickness on the medial femoral condyle were observed between the SA and control groups (2.077 mm and 2.237 mm, respectively; p = 0.021). There were no significant differences in cartilage thickness between the first and last follow-ups in the SA knees. The proposed treatment could lead to a faster eradication of infection, and thus protect against the early development of osteoarthritis. The quadriceps peak torque deficit may persist afterwards at a mean of 18.1 years follow-up.