Patients treated with surgical irrigation and debridement for infection after ACL reconstruction have a high rate of subsequent knee surgery

Robert H. Brophy, Laura J. Huston, Rick W. Wright, Xulei Liu, Annunziato Amendola, Jack T. Andrish, David C. Flanigan, Morgan H. Jones, Christopher C. Kaeding, Robert G. Marx, Matthew J. Matava, Eric C. McCarty, Richard D. Parker, Michelle L. Wolcott, Brian R. Wolf, Kurt P. Spindler

Research output: Contribution to journalArticle

Abstract

Objectives The purpose of this cross-sectional study was to describe the rates of additional surgery and patient-reported outcomes in patients who underwent surgical irrigation and debridement (I&D) for infection following anterior cruciate ligament reconstruction (ACLR) and test the hypothesis that additional surgery is associated with worse patient-reported outcomes. Methods Patients diagnosed with a postoperative infection following ACLR (defined as one requiring surgical treatment with either a deep or superficial I&D) were identified from a prospective cohort. Both primary and revision ACLRs were included, as well as any graft type (autografts and allografts). Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS] and Marx activity level) and subsequent surgeries were collected at 2-year and 6 year follow-up from the initial ACLR surgery. Baseline demographics and 2-year and 6-year outcomes (from initial ACLR) were compared between patients who did or did not undergo additional surgery subsequent to I&D using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. Results Twenty-one of 3210 ACLR patients (0.7%) had a postoperative infection requiring surgical I&D. This group consisted of 12 men and 9 women, mean (SD) age of 25.8 (11.3) years, 18 primary and 3 revision ACLRs and 16 autografts and 5 allografts. The mean time from ACLR to the surgical I&D was 39 days. In these patients, IKDC scores improved from 44±17 prior to initial ACLR to 83±16 at 6-year follow-up (p<0.001). While all KOOS scores improved from baseline to final follow-up, activity level decreased from 11±6 to 7±5 points (p<0.001). Follow-up related to subsequent surgery was obtained on 20 of 21 patients (95%). Forty per cent of the infection group (n=8 of 20) underwent additional surgery following their I&D, with three patients (15%) undergoing revision ACLR and one patient (5%) undergoing total knee arthroplasty. Patients who underwent additional surgery had lower Marx activity at 2 years compared with patients who had no subsequent surgeries (4±3vs 9±5 points, p=0.018). Conclusion Patients who undergo I&D for an infection following ACLR have a high rate of additional surgery but still attain reasonable clinical outcomes 6 years after ACLR. Level of evidence IV

Original languageEnglish
Pages (from-to)73-78
Number of pages6
JournalJournal of ISAKOS
Volume4
Issue number2
DOIs
StatePublished - Mar 1 2019

Keywords

  • Acl Pcl
  • outcome studies
  • repair reconstruction

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    Brophy, R. H., Huston, L. J., Wright, R. W., Liu, X., Amendola, A., Andrish, J. T., Flanigan, D. C., Jones, M. H., Kaeding, C. C., Marx, R. G., Matava, M. J., McCarty, E. C., Parker, R. D., Wolcott, M. L., Wolf, B. R., & Spindler, K. P. (2019). Patients treated with surgical irrigation and debridement for infection after ACL reconstruction have a high rate of subsequent knee surgery. Journal of ISAKOS, 4(2), 73-78. https://doi.org/10.1136/jisakos-2018-000264