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Document Title: Musso-CJSM-Sep05.shtml
Article Title: Infection After ACL Reconstruction: What Happens When Cultures Are Negative?
Authors: Musso, A D MD; McCormack, R G MD, FRCS(C)
Publication: Clinical Journal of Sports Medicine, Lippincott Williams and Wilkins Inc.
Date: September 2005,
Volume 15(5), pages 381-384
Keywords: ACL reconstruction, postoperative complications, post-surgery infection, septic arthritis, epidemiology.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This article discusses strategies for dealing with intraarticular infection subsequent to ACL reconstruction, and focuses on cases where bacterial culture (i.e. aspiration from the surgical wound site) reveals nothing. The rate of post-surgical infection is generally very low (e.g. 0.2%), but sometimes there are clusters of elevated infections (e.g. 7.75% from September 2003 to February 2004, in this particular study). The authors note that when the clinical signs (i.e. fever, chills, also wound drainage and redness) of deep intraarticular infection are present, or when there is reason to suspect such infection, then it is appropriate to begin intravenous (IV) antibiotic therapy immediately (rather than waiting until final microbiological-laboratory test result have been received). The authors feel that surgery (i.e. reopening the knee and removing infected issue, pockets of pus, etc.) is mandatory if a prompt response to IV antibiotic therapy does not occur. In any case, promptly dealing with intraarticular infections is important, since the longer such an infection is allowed to linger, the more damage is done to the vulnerable articular-cartilage surfaces. Such damage would then be termed septic arthritis.
Abstract
We examined an epidemic outbreak of 9 cases of infected ACL reconstructions and developed a treatment algorithm for cases with negative cultures but clinical signs of infection in a period of 6 months. The importance of appropriate cultures prior to antibiotics is reinforced and the assessment of a cluster of infections is highlighted.
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