Stage-adapted treatment of infection after reconstruction of the anterior cruciate ligament

Abstract

Debridement and irrigation of the knee joint and the donor site to reduce the amount of bacteria and to remove bacterial enzymes and inflammatory cytokines in cases with infection after replacement of the anterior cruciate ligament (ACL). Proven infection, suspected infection. High anesthesiological risk. The therapy of infections after ACL reconstruction depends on the different stages as described by Gächter. In stageI and II, arthroscopic debridement and irrigation (about 10l) of all compartments is performed. Several biopsies for microbiological analysis are obtained during surgery. Broad-spectrum antibiotic therapy started immediately after surgery. Once the resistance of the bacteria is known, antibiotic therapy may be changed according to the results. When pain, swelling, elevated CRP, or white blood cells persists, arthroscopic irrigation is repeated. In stageIII, a complete arthroscopic synovectomy is performed. When the graft is intact, it is left in situ. Resection is performed in case of graft insufficiency, tunnel malplacement, or persistent infection. When the bone tunnels are affected, they should be debrided. In stageIV with osteolysis, an arthrotomy with open debridement may be required. The surgical therapy can be supported with the application of local antibiotics. Redon drainage is left in situ until the next irrigation is performed, control of wound and laboratory results, passive exercises, physiotherapy, systemic antibiotic therapy. Between 2008 and 2013, we treated 13 patients with an infection after replacement of the ACL. In all cases, complete healing was achieved. In 4cases, the graft was resected. In 2patients, arthrofibrosis developed and arthrolysis was required.