Arthroscopic treatment of acute septic arthritis after meniscal allograft transplantation

We present the 30-month follow-up results of an acute septic arthritis of the knee after meniscal allograft transplantation, which was successfully treated with graft retention. A 21-year-old man presented with a 4-month history of right knee pain following arthroscopic subtotal lateral meniscectomy. Plain radiographs showed there was no arthritic change with neutral limb alignment. Fourteen days after meniscal allograft transplantation, septic arthritis was confirmed with positive cultures for Staphylococcus epidermidis, and arthroscopic debridement and irrigation were performed. The suggested procedures of our treatment regimen include arthroscopic debridement and irrigation with >or=10 L of normal saline as soon as possible after diagnosis or a clinical suspicion is reached, repeated irrigation under the local anesthesia and intravenous antibiotics until clinical symptoms and laboratory results improve. The decision to repeat the debridement was based on clinical and laboratory results. We reevaluated the patients the third or fourth day after every arthroscopic treatment. At last follow-up, 2 years after the final operation, the patient had no clinical sign of infection. Erythrocyte sedimentation rate and C-reactive protein level were normal and plain radiographs indicated no arthritic change. Further the patient had full pain-free range of knee motion. At this time the Lysholm knee score was 89 and the Tegner score was 5. Magnetic resonance imaging 30 months postoperatively revealed slight (3 mm) extrusion without tear. This case is notable because it shows that early aggressive arthroscopic debridement and repeated irrigation with graft retention can be an effective treatment regimen in selected cases.