Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction:...

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomedical Research

Background:

• Post-operative infection following anterior cruciate ligament (ACL) reconstruction is a significant concern.
• A comprehensive understanding of infection incidence, causative pathogens, and risk factors is crucial for improving patient outcomes.

Approach:

• A systematic literature review was conducted across PubMed, CINAHL, EMBASE, and Scopus databases.
• Fifty studies, encompassing 316,214 primary ACL reconstructions, were included after rigorous screening.
• Data on infection incidence, microbial pathogens, and identified risk factors were extracted and analyzed.

Key Points:

• The overall incidence of infection after ACL reconstruction was found to be 0.60% (95% CI: 0.15-2.44%).
• Staphylococcus species, including Staphylococcus aureus and S. epidermidis, were the most prevalent pathogens, accounting for 84% of culture-positive infections.
• Hamstring autograft use was identified as a significant risk factor, alongside male sex, immunosuppression, intra-articular steroid injections, prior knee surgery, and diabetes.

Conclusions:

• Infection following ACL reconstruction is an infrequent complication.
• Staphylococcus species are the predominant pathogens, highlighting the importance of appropriate antibiotic prophylaxis and surgical site preparation.
• Identifying and mitigating risk factors, such as hamstring autograft use, can aid in the prevention and management of post-ACL reconstruction infections.