Treatment of persistent infection after anterior cruciate ligament surgery

Infection after anterior cruciate ligament reconstruction that persists despite debridement is a challenging problem with limited information available in the literature. Our purpose was to determine whether an aggressive protocol would be effective in treating these persistent infections. This is a retrospective review of five consecutive patients with persistent septic arthritis of the knee after anterior cruciate ligament reconstruction. All patients previously had one to three irrigation and debridement procedures that failed to control the infection. Our treatment protocol consists of arthrotomy, complete synovectomy, removal of any implants, graft removal, and curettage of the femoral and tibial tunnels. Cultures are obtained from many sources (joint fluid, synovial lining, graft, and bone) and antibiotic therapy is given for 6 weeks. At a median followup time of 20 months (range, 6-27 months) infection was controlled in all patients. Three of five infections (60%) were polymicrobial. In these cases, different organisms were cultured from multiple tissue samples. Tunnel osteomyelitis was present in three of five patients (60%). Persistent septic arthritis of the knee after anterior cruciate ligament reconstruction can be controlled with a protocol based on radical debridement. Polymicrobial infections may be present and multiple cultures from different sources are required to identify all pathogens.