Approaches to Septic Arthritis of the Knee Post Anterior Cruciate Ligament Reconstruction

Septic arthritis of the knee following anterior cruciate ligament reconstruction is a rare but potentially deleterious complication. The main approach to the management of this potentially devastating complication in recent years has involved a more aggressive attempt at preventing graft contamination during surgery with the adoption of the pre-soaking of the graft in broad-spectrum antibiotic solution, and early and adequate treatment of established cases of knee sepsis, with or without retention of the graft. However, what constitutes an early and adequate initial treatment may be a challenging decision for the surgeon to make in certain instances.

Graft pre-soaking in vancomycin has been noted to significantly reduce the incidence of septic arthritis of the knee following anterior cruciate ligament reconstruction. Other studies have recorded similar satisfactory results with graft pre-soaking in gentamycin. In established cases of infection, irrigation and debridement with either graft retention or graft excision with delayed re-construction of the anterior cruciate ligament have both given satisfactory results in well-selected patients. Septic arthritis of the knee following anterior cruciate ligament reconstruction can be prevented by careful patient selection, use of prophylactic antibiotics, strict asepsis during surgery, and graft pre-soaking in antibiotic solution. The choice of antibiotic solution for graft pre-soaking is influenced by the surgeon's preference, tissue penetrance, effect on graft tensile strength, local bio-gram of the micro-organisms, and the sensitivity pattern. The treatment option in established cases would depend on the stage of infection, state of the graft, and the extent of bony involvement.