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Massive bone loss from fungal infection after anterior cruciate ligament arthroscopic reconstruction
D Luis Muscolo1, Lisandro Carbo, Luis A Aponte-Tinao
1Institute of Orthopedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Potosí 4215, 1199, Buenos Aires, Argentina. luis.muscolo@hospitalitaliano.org.ar
Abstract:
Although there are numerous reports of septic pyogenic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction, there is limited information regarding the outcomes of fungal infection. We determined the outcomes of six patients with mycotic infection after regular ACL reconstruction. There were four males and two females with a mean age of 33 years. We determined the number of procedures performed, bone loss originating to control infection, and final reconstruction in these patients. An average of five arthroscopic lavage procedures had been performed at the referring centers. Fungal infection was diagnosed based on pathologic samples; five infections were the result of mucormycosis and one was Candida. After final débridement, the mean segmental bone loss was 12.8 cm. All patients were treated with intravenous antifungal coverage and cement spacers before final reconstruction. At final followup, all patients were free of clinical infection. Three had reconstruction with an allograft-prosthesis composite, two with hemicylindrical allografts, and one with an intercalary allograft arthrodesis. Despite the extremely unusual presentation of this complication, surgeons should be aware of potential and catastrophic consequences of this severe complication after ACL reconstruction.
Insights
Fungal infections after anterior cruciate ligament (ACL) reconstruction are rare but serious. This study found that prompt antifungal treatment and surgical intervention led to successful outcomes in six patients with mycotic infections.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Research
Background:
- Septic pyogenic arthritis is a known complication following arthroscopic anterior cruciate ligament (ACL) reconstruction.
- Information on the outcomes of fungal infections after ACL reconstruction is limited.
Purpose of the Study:
- To determine the outcomes of mycotic infections in patients who underwent ACL reconstruction.
- To highlight the management and results of fungal infections complicating ACL repair.
Main Methods:
- Retrospective analysis of six patients with fungal infections post-ACL reconstruction.
- Review of diagnostic methods, surgical procedures, bone loss, antifungal treatments, and final reconstruction techniques.
- Pathologic samples were used for fungal diagnosis; five cases were mucormycosis, one was Candida.
Main Results:
- Patients underwent an average of five arthroscopic lavage procedures prior to definitive treatment.
- Mean segmental bone loss was 12.8 cm after débridement.
- All patients received intravenous antifungal therapy and cement spacers before final reconstruction, achieving clinical infection-free status.
Conclusions:
- Fungal infections, though rare, represent a severe complication after ACL reconstruction.
- Awareness of these potential catastrophic consequences is crucial for surgeons.
- Successful management involves aggressive débridement, antifungal treatment, and staged reconstruction.