Aseptic Effusion Research Articles

Clinical and Functional Results Using Autologous Conditioned Serum in the Treatment of Acute Ankle Injuries in Sporting Activities

Background: Ankle ligament injuries in the sports like basketball, volleyball, and cricket are the most common reasons for missed participation in athletics, accounting for 14% of all sports injuries. These injuries may often require splinting and rest for a longer duration, leading to a permanently reduced level of sports performance. The autologous conditioned cytokine-rich serum (ACRS) is becoming a reliable treatment option in acute ankle injuries as it enhances biological healing. The objective of this study is to evaluate the role of ACRS in acute ankle injuries and report the efficacy of ACRS injections on time to return to physical activities.
 Methods: 42 patients with clinical and radiological signs of ankle ligamentous injuries (grades 1 and 2) secondary to sporting or gaming activity were recruited for this study. Each patient received one injection of ACRS at the injury site and was put on a soft cast for one week. Clinical and functional evaluation was performed using the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, and the Foot and Ankle Disability Index (FADI) scores before the injection, at one week, i.e., after removing the soft cast, three weeks, six weeks, and three months.
 Results: Our study showed gradual improvement of all the evaluation scales at all the follow-ups. Few patients showed minor side effects like aseptic effusion. The least common complaint was a pain in the subsequent days after the injection.
 Conclusion: Our results, in conjunction with pre-existing studies in the literature regarding the biological effects of ACRS, demonstrate the viability of this therapy for the treatment of acute ankle injuries, showing the positive influence on pain and healing capacity and returning to gaming activities immediately in about two weeks without significant adverse effects.

Diagnostic Criteria for the Painful Swollen Pediatric Knee: Distinguishing Septic Arthritis From Aseptic Effusion in a Non-Lyme Endemic Area.

Purpose: The child with a painful swollen knee must be worked-up for possible septic arthritis; the classic clinical prediction algorithms for septic arthritis of the hip may not be the best models to apply to the knee.Materials and methods: This was a retrospective case-control study of 17 years of children presenting to one hospital with a chief complaint of a painful swollen knee, to evaluate the appropriateness of applying a previously described clinical practice algorithm for the hip in differentiating between the septic and aseptic causes of the painful knee effusions. The diagnoses of true septic arthritis, presumed septic arthritis, and aseptic effusion were established, based upon the cultures of synovial fluid, blood cultures, synovial cell counts, and clinical course. Using a logistic regression model, the disease status was regressed on both the demographic and clinical variables.Results: In the study, 122 patients were included: 51 with true septic arthritis, 37 with presumed septic arthritis, and 34 with aseptic knee effusion. After applying a backward elimination, age <5 years and C-reactive protein (CRP) >2.0 mg/dl remained in the model, and predicted probabilities of having septic knee arthritis ranged from 15% for the lowest risk to 95% for the highest risk. Adding a knee aspiration including percent polymorphonucleocytes (%PMN) substantially improved the overall model performance, lowering the lowest risk to 11% while raising the highest risk to 96%.Conclusions: This predictive model suggests that the likelihood of pediatric septic arthritis of the knee is >90% when both “age <5 years” and “CRP > 2.0 mg/dl” are present in a child with a painful swollen knee, though, in the absence of these factors, the risk of septic arthritis remains over 15%. Aspiration of the knee for those patients would be the best next step.

Knee infection following anterior cruciate ligament reconstruction: a cohort study of one thousand, eight hundred and ninety one patients from the single-centre database.

This study was undertaken to retrospectively determine the incidence of postoperative knee infection following ACL reconstruction, to identify the most common causative pathogen and to evaluate our diagnostic and treatment approach, as well as to review current recommendations for the management of septic arthritis. From January 2007 to December 2017, a total of 1891 arthroscopic ACL reconstructions were performed at our institution. Twenty-nine cases with clinical suspicion of post-operative septic knee arthritis following ACL reconstruction were identified and retrospectively analysed with regard to incidence, clinical presentation, microbiological spectrum, laboratory parameters and number of arthroscopic debridements. Three patients were classified as aseptic effusion and were excluded from the further analysis. Patients were treated with antibiotic therapy (IV and oral) and repeated arthroscopic debridement. Twenty-six (1.4%) out of 1891 patients were diagnosed with joint infection and were treated with arthroscopic debridement and intravenous antibiotics. Inthe majority of cases (58.69%), microbiological analysis failed to identify the causative pathogen and in those where the pathogen was isolated, the most common was methicillin-resistant Staphylococcus epidermidis (45.45%). Mean time interval from reconstruction to onset of symptoms was 23.54 ± 21.00 (6-100) days. The mean number of arthroscopic irrigations and debridements was 1.23 ± 0.51 (1-3) per patient. In all, twenty-six cases of graft was retained. Septic arthritis following ACL reconstruction is a rare but serious complication. We conclude that prompt treatment consisting of repeated arthroscopic irrigation and debridement with course of antibiotic therapy is an effective therapeutic intervention that leads to graft and hardware retention.

Incidence, Risk Factors, and Management of Infection Following Anterior Cruciate Ligament Reconstruction Surgery.

Background:Infection after anterior cruciate ligament reconstruction surgery (ACLRS) is a rare complication. Although there are number of studies from various Caucasian population but only few studies are available from Asian population. The aim of the study is to assess the incidence, risk factors and, clinical outcome using our treatment protocol.Materials and Methods:Out of 1468 arthroscopic ACLRS, 26 patients with clinical suspicion of infection were critically analysed in terms of laboratory reports of arthrocentesis, erythrocyte sedimentation rate, C-reactive protein and risk factors such as the type of graft, gender, diabetes mellitus, smoking, intraarticular steroid injection, and obesity. At final followup, all these patients were evaluated using visual analog scale (VAS), Lysholm knee score, and Tegner activity level.Results:In nine patients, culture did not show any growth and they showed improvement with arthrocentesis and oral antibiotics. These patients were labeled as suffering from aseptic effusion. In the remaining 17 patients, there was no clinical improvement or instead worsening of symptoms after arthrocentesis and oral antibiotics. These patients were labeled as suffering from an infection and underwent surgical debridement along with administration of injectable antibiotics. The history of intraarticular steroid injection before ACLRS was a significant risk factor for developing infection (P = 0.001). At mean followup of 2.8 years, mean VAS improved to 1.18 ± 0.99 from 6.2 ± 2.3. The mean Lysholm knee score and Tegner's activity level at the final followup were 79.2 ± 10.52 and 4.8 ± 2.30, respectively.Conclusion:The incidence of infection was 1.2% (17/1468). The step-ladder approach of differentiating between aseptic effusion and infection and accordingly, following a treatment protocol, i.e., oral antibiotics alone or surgical debridement along with injectable antibiotics or additional debridement of graft in refractory patients, yielded satisfactory results.

A Rare Case of Neck Pain: Acute Longus Colli Calcific Tendinitis in a Possibly Immunocompromised Individual

We present a rare case of severe neck pain in a 45-year-old man with severe hidradenitis suppurativa who was participating in a study involving adalimumab. The neck pain was associated with acute longus colli calcific tendinitis, which is a noninfectious inflammatory response in the longus colli tendons secondary to deposition of calcium hydroxyapatite crystal. The diagnosis was made by computed tomography, which showed calcifications and deposits, and magnetic resonance imaging, which showed a retropharyngeal effusion. Ears, Nose, and Throat Services performed a fiberoptic scope examination, which revealed a patent airway and no drainable abscess. Nonsteroidal anti-inflammatory drugs resulted in a dramatic improvement in the patient's clinical symptoms. In acute longus colli tendinitis, differentiating retropharyngeal aseptic effusion from infection is important. Of note, the confounding factor in this case was that the patient was blinded to whether he was receiving the placebo or adalimumab, so whether the patient was immunosuppressed and at risk for infection was unknown. Clinician familiarity and education concerning acute calcific longus colli tendinitis may lead to decreased costs stemming from incorrect diagnosis and unnecessary treatment.

Failures in bipolar fresh osteochondral allograft for the treatment of end-stage knee osteoarthritis

Bipolar fresh osteochondral allografts (BFOA) recently became a fascinating option for articular cartilage replacement, in particular in those young patients non-suitable for traditional replacement because of age. While the use of osteochondral allografts for the treatment of focal osteochondral lesions in the knee is well established, their use in the treatment of end-stage arthritis is far more controversial. The purpose of this paper is to describe our experience in a series of seven patients who underwent a resurfacing of both tibio-femoral and patello-femoral joints by BFOA. From 2005 to 2007, seven patients (mean age 35.2 ± 6.3 years) underwent BFOA for end-stage arthritis of the knee. Patients were evaluated clinically, radiographically and by CT scan preoperatively and at established intervals up to the final follow-up. No intra-operative complications occurred. Nevertheless, joint laxity and aseptic effusion, along with a progressive chondrolysis, lead to early BFOA failure in six patients, which were revised by total knee arthroplasty at 19.5 ± 3.9 months follow-up. Only one patient, who received the allograft to convert a knee arthrodesis, gained a satisfactory result at the last follow-up control. BFOA in the knee joint still remains an inapplicable option in the treatment of post-traumatic end-stage arthritis of the young patient, due to the high rate of failure. Further studies are necessary in order to investigate the causes of failure and improve the applicability of this method. Still, after extensive counselling with the patient, BFOA may represent a salvage procedure aimed to revise scarcely tolerated knee arthrodesis. Retrospective case series, Level IV.

AB0646 Intra-articular level of c-reactive protein in diagnosis of prosthetic knee infection

BackgroundPeriprosthetic joint infection is a rare but potentially serious complication. In 2012, Parvizi et al. suggested intra-articular C-reactive protein (CRP) could be used as a diagnosis marker of periprosthetic joint...

Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction

Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.

Interlobar Effusion Associated with Heart Failure

INTERLOBAR effusion is associated in the minds of most general practitioners with infection in the lungs. The usual source of infection is pneumonia, lung abscess, or tuberculosis. That it can occur as an aseptic effusion has been recognized by a few observers. A common cause of aseptic effusion which should be kept in mind by those interested in diseases of the chest is an effusion occurring with cardiac failure. Stewart (1), in 1928, was the first to describe the occurrence of encapsulated interlobar effusion in a case of cardiac failure. The heart disease was a primary atherosclerosis. The effusion disappeared with recovery of the patient and reappeared with the subsequent cardiac failure. The accumulation of the fluid was a primary pleural process and was due to previous obliteration of the peripheral pleural cavity, leaving the interlobar space as the only one into which transudation could occur. In addition to this case of Stewart's, Kiser (2), in the next year, reported a case of myocardial failure with congestion. Steele (3), in 1931, reported two additional cases in which interlobar fluid appeared, in the right upper half of the chest, with recurrent attacks of heart failure, and disappeared with the disappearance of the edema and with general recovery. These shadows reappeared with the second attack. One case came to autopsy and showed obliteration of all pleural spaces except the one between the upper and middle lobes, where 250 c.c. of fluid was found. For the effusion to be limited to the interlobar space, Steele concluded that extensive adhe sions are necessarily antecedent to the development of the heart failure. In 1931, Freedman (4) reported a case of effusion between the right upper and middle lobes. This patient had a coronary occlusion and an aneurysm of the left ventricle. Freedman emphasized the fact that interlobar effusion must be differentiated from localized marginal pneumonia and bronchial carcinoma. He further stated that in the presence of a pneumonia the only x-ray sign of interlobar effusion is a bulging of the interlobar fissure seen in the lateral view. Austrian (5), in 1932, reviewed the literature and added his own case which showed an interlobar effusion during periods of congestive heart failure. At postmortem there was found an antecedent obliterative pleurisy, probably of tuberculous origin, so that the interlobar space was the only one in which the fluid could accumulate. All of the cases he reviewed had coronary disease or disease of the aorta near the ostia of these vessels. The fluids found were all on the right side. Stein and Schwedel (6), in 1934, stated that interlobar effusion in patients with cardiac failure is not uncommon. The cases they described also occurred with pleural effusion.