Arthroscopic irrigation and debridement in the treatment of septic arthritis after anterior cruciate ligament reconstruction

Arthroscopy. 2014 Jun;30(6):747-54. doi: 10.1016/j.arthro.2014.02.015. Epub 2014 Mar 27.

Abstract

Purpose: To systematically review the literature and characterize the success and failure rates of arthroscopic irrigation and debridement (I & D) in the treatment of septic arthritis after anterior cruciate ligament (ACL) reconstructions. We also aimed to identify which variables affected the failure rate.

Methods: Five databases (MEDLINE, Ovid, Medscape, Web of Science, and Google Scholar) were screened for clinical studies involving the treatment of septic arthritis after ACL reconstruction with arthroscopic I & D. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. Failure of I & D was defined as the need for graft removal or revision ACL reconstructive surgery because of infection. Data from the selected studies were combined for statistical analyses to elucidate factors associated with the success or failure.

Results: We identified 11 eligible studies involving 90 patients. These studies described the results of 90 arthroscopic I & D procedures with an overall success rate of 85.6%. Repeated I & D was necessary in 34.5% of patients. Removal of the graft with or without subsequent revision ACL reconstruction was reported in 13 (14.4%) cases. Statistical analysis showed that cases involving Staphylococcus aureus (P = .053), 2 or more I & D procedures (P = .029), and allografts (P < .0001) were at greater risk of failure.

Conclusions: Arthroscopic I & D with graft retention is an effective treatment for patients with septic arthritis after ACL reconstruction. Factors affecting the failure rate may include graft choice and organism virulence.

Level of evidence: Level IV, systematic review of Level IV studies.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Reconstruction / adverse effects*
  • Arthritis, Infectious / etiology
  • Arthritis, Infectious / therapy*
  • Arthroscopy / adverse effects
  • Debridement / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Plastic Surgery Procedures / adverse effects
  • Staphylococcal Infections / therapy
  • Staphylococcus aureus
  • Therapeutic Irrigation / methods*
  • Transplantation, Homologous
  • Treatment Outcome
  • Young Adult