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In
septic arthritis patients, clinicians may use arthroscopic debridement with
hardware removal after ACL reconstruction.
A recent case series illustrated that arthroscopic debridement with hardware removal was effective in eradicating the infections after ACL (anterior cruciate ligament) reconstruction with extra-articular fixation. The graft integrity was preserved without compromising knee stability.
The analysis was carried out to examine the functional and clinical impact of septic arthritis patients after ACL reconstruction who underwent arthroscopic debridement, while preserving the graft but eliminating the fixation devices. It also determined the impact of premature hardware removal on the integrity and function of the graft.
A total of 24 patients with postoperative septic arthritis (21 primary and 3 revision) were identified for the analysis from a cohort of 2384 arthroscopic ACL reconstruction cases (2143 primary and 241 revision). The Lysholm score, IKDC (International Knee Documentation Committee) form, WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and Tegner score at a minimum follow-up of 12-months were utilized to examine 18 participants.
Using standardized manual laxity tests, the knee laxity was assessed clinically. Using an arthrometer and a triaxial accelerometer, the knee laxity was estimated instrumentally. Furthermore, at the final follow-up, 3-T MRI (magnetic resonance imaging) was performed, focusing on the occurrence of arthrofibrosis, graft signal, and the cartilage status.
In all the cases, eradication of the infection was achieved. Due to insufficient tension, graft removal was performed only in 1 of 24 patients (4%). The arthroscopic debridement technique with hardware removal effectively eradicated the infection in 21 cases (91%) among the remaining 23 participants.
At the last follow-up, 2 subjects needed a further ACL revision approach. The mean IKDC, WOMAC, Lysholm, and Tegner scores of the patients available for the clinical evaluation were 75±19, 90±8, 79± 21, and 6±2, respectively as depicted in Table 1:
|
|
Mean ±
SD (Range) (n = 16) |
|
WOMAC |
90 ± 8
(75-100) |
|
Lysholm |
79 ± 21 (33-100) |
|
IKDC (subjective) |
75 ± 9
(46-100) |
|
Tegner |
|
|
Before injury |
8 ±
2 (5-10) |
|
Last follow-up |
6 ±
2 (3-10) |
Table 1: Subjective Outcome Scores
No abnormal laxity was reported on manual testing. Better knee stability was witnessed in Arthrometric and accelerometer tests (at manual maximum force, mean KT-1000 arthrometer side-to-side difference was found to be 1.6 ± 1.2 mm).
In 50% of cases, the MRI findings revealed a good graft signal. In 81% of participants (13 cases), the concomitant signs of arthrofibrosis were found. In 63% of patients (10 cases), severe cartilage defects (International Cartilage Repair Society grade 3) were reported as depicted in Table 2:
|
|
No. of patients (%) |
|
Arthrofibrosis |
13 (81%) |
|
Severe cartilage defects |
10 (63%) |
Table 2: MRI Findings of Arthrofibrosis, and Cartilage Degeneration at Final Follow-up
Thus, arthroscopic debridement with hardware removal is effective in eradicating infections while not compromising graft integration and function.
The American Journal of Sports Medicine
Graft-Preserving Arthroscopic Debridement With Hardware Removal Is Effective for Septic Arthritis After Anterior Cruciate Ligament Reconstruction
Mirco Lo Presti et al.
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