Infection after reconstruction of the anterior cruciate ligament

Abstract

Aim: Postoperative infection after the anterior cruciate ligament reconstruction (ACLR) can destroy the knee cartilage, necessitate graft removal, and cause arthrofibrosis, instability, limitation of motion, chronic pain, and disability. While being an uncommon complication, the actual number of infected patients might be rather high due to a large number of operations performed. As the operation is usually indicated in young, healthy, and active individuals, failure to achieve the expected improvement, due to complications, is perceived as much graver. The purpose of this study was to analyze the infecting organisms in patients that underwent ACLR at our institution, a tertiary care center, for precise microbiological diagnosis and bacterial susceptibility and resistance to antibiotics. Methods: The rate of infection, the infecting organisms, the antibiotic susceptibility, and the resistance were analyzed in 1,395 patients that underwent ACLR using descriptive statistics. Results: Three patients (0.93%) were diagnosed with a postoperative infection; all underwent arthroscopic debridement and lavage. All infections were caused by Staphylococci [3 Staphylococcus aureus (S. aureus, all oxacillin sensitive), 6 coagulase-negative Staphylococci (3 oxacillin resistant)]. No gram-negative, gastrointestinal tract bacteria, fungal or polymicrobial infections were detected. Thirty eight and a half percent of patients had returned to previous or near previous levels of activity. Conclusions: Preventing infection by controlling risk factors, prophylactic antibiotics, proper surgical preparation, and surgical technique is mandatory. When infection does occur, rapid recognition and prompt treatment are necessary to avoid irreversible damage to the knee joint and the need for graft removal. Despite appropriate treatment, the functional outcomes were inferior to expected after an uncomplicated ACLR.