SEPTIC ARTHRITIS AFTER ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION - DIAGNOSIS AND MANAGEMENT

We performed a retrospective study of knee joint infections after arth roscopic anterior cruciate ligament reconstruction at our institution. Two thousand five hundred anterior cruciate ligament reconstructions were performed between 1988 and 1993. Seven (0.3%) patients experience d postoperative deep infections of the knee. Ail anterior cruciate lig ament reconstructions were performed using arthroscopically assisted t echniques. Six (86%) of these patients had concomitant open procedures performed, including meniscal repair, posterolateral corner reconstru ction, and medial collateral ligament reconstruction. Four patients ha d acute (< 2 weeks), two patients had subacute (2 weeks to 2 months), and one patient had late (> 2 months) infections. All patients had pos itive cultures from knee joint aspirates with the organisms Staphyloco ccus aureus, Staphylococcus epidermidis, Peptostreptococcus, or a comb ination thereof. All patients underwent immediate arthroscopic irrigat ion and debridement. All infections were intraarticular; six patients also had extraarticular sites of infection. Four patients underwent re peat irrigation and debridement at approximately 1 week. The anterior cruciate ligament graft was removed from four patients. All patients w ere treated with intravenous antibiotics for 4 to 6 weeks, protected w eightbearing, and physical therapy. At a mean followup of 29 months, m ean knee extension was 0 degrees, and mean knee flexion was 122 degree s (range, 70 degrees to 135 degrees). Six (86%) patients had minimal t o no pain in their operative knee, and they were satisfied with their functional results.