Graft retaining debridement in patients with septic arthritis after anterior cruciate ligament reconstruction

Although septic arthritis following anterior cruciate ligament (ACL) reconstruction is a rare complication, it has a high morbidity deteriorating the clinical outcome. Current treatment options include long-term antibiotic therapy, open or arthroscopic surgical lavage, aspiration, continuous irrigation, graft preservation, and removal of graft and fixation materials with or without reimplantation. The aim of our study was to evaluate the results of long-term antibiotic treatment with arthroscopic debridement without graft and fixation materials removal in the treatment of septic arthritis following ACL reconstructions.

Seven patients (6 male, 1 female; mean age: 29 years; range: 21 to 40 years) who had septic arthritis following ACL reconstruction at Uludag; University, Department of Orthopaedics and Traumatology were included in this study. Three of the patients were athletes, 1 was a heavyduty worker, 3 were light-medium-duty workers and 1 was an amateur sportsman. Long-term antibiotic therapy was used for 6 weeks. Rehabilitation was arranged according to the patients effusion, pain and general condition. Evaluations were made using clinical results, manual Lachman and pivot shift tests, and Tegner activity, Lysholm, and IKDC scores.

Patients had a mean of 6 (range: 0 to 15) degrees of flexion loss and 3 (range: 0 to 5) degrees of extension loss. Manual Lachman test was near normal for all patients. Pivot shift was positive for 3 and negative for 4 patients. Preoperative and postoperative mean Tegner activity scores were 6 (range: 4 to 7) and 5 (range: 4 to 7), respectively. Preoperative and postoperative mean Lysholm scores were 73.2 (range: 67 to 79) and 74.1 (range: 79 to 89), respectively. Preoperative and postoperative mean IKDC scores were 78.0 (range: 70 to 100) and 80.0 (range: 70 to 100), respectively. Mean leg circumference across the quadriceps muscle was 91% (range: 88 to 93) of the contralateral leg. Single-leg longitudinal jumping length was 78% (range: 63 to 100) of the uninvolved leg. Single-leg horizontal jumping was 72% (range: 88 to 93) of the contralateral leg.

Long-term antibiotic therapy and arthroscopic drainage without graft or fixation material removal is effective in patients of regular activity level. Although this procedure is equally successful for treating the infection in competitive athletes and heavy workers, it also results in slight performance loss. Further review is necessary to determine which treatment is suitable for which activity level.