Clinical and Laboratory Changes in the Uncomplicated Course of Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction: A Prospective Observational Study in 58 Patients

Abstract

Knowledge of post-operative clinical and laboratory changes in the uncomplicated course of ACL reconstruction could assist orthopaedic surgeons in making a timely diagnosis of septic arthritis. A total of 58 candidates to ACL reconstruction were enrolled in this study according to inclusion/exclusion criteria. Pre- and post-operative changes on 1st, 3rd, 7th, 15th, and 30th day were collected for skin body temperature (SBT), knee pain (KP), white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Post-operative joint effusion was recorded when inhibiting quadriceps contraction. The post-operative changes were compared with baseline values at each time point in the whole sample and in the subgroups of patients receiving bone-patellar-tendon-bone (BPTP) or hamstring tendon (HT) autograft. Follow-up at six month was considered adequate to rule out surgery-related septic arthritis. Mean SBT significantly increased on 1st, 3rd and 7th post-operative day and returned to values not differing from baseline on 15th and 30th day. Median KP was significantly elevated during the first month. Joint effusion was observed on 7th post-operative day in 52% of patients. Mean WBC count significantly increased on 1st, 7th and 15th day while no difference from baseline was observed on 3rd and 30th day. Mean ESR was significantly elevated on 1st day, increased on 3rd day and peaked on 7th day. ESR decreased on 15th and 30th day but remained significantly higher than baseline. Mean CRP significantly increased on 1st day, peaked on 3rd day and decreased on 7th day, while levels on 15th and 30th day did not differ from baseline. The SBT, KP, WBC count, ESR and CRP changes stratified in relation to the type of autograft showed the same variation trend as in the whole sample. Close clinical surveillance may be advisable when SBT, occurrence of joint effusion and CRP levels deviate from the described reference trend two weeks after surgery.