Infection after arthroscopic anterior cruciate ligament reconstruction

Orthopedics. 2014 Jul;37(7):477-84. doi: 10.3928/01477447-20140626-06.


Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4-218 months). An average of 1.92 procedures (range, 1-5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5-90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23-100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction / adverse effects*
  • Arthritis, Infectious / diagnosis
  • Arthritis, Infectious / etiology
  • Arthritis, Infectious / microbiology*
  • Arthroscopy
  • Debridement
  • Humans
  • Recovery of Function