Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol
Management of septic arthritis after arthroscopic anterior cruciate ligament reconstruction using a standard surgical protocol
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DOI：
10.1016/j.knee.2017.02.007
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发表时间：
2017-06-01
期刊：
影响因子：
1.9
通讯作者：
Malizos, Konstantinos N.
中科院分区：
文献类型：
--
作者：
Hantes, Michael E.;Raoulis, Vasilios A.;Malizos, Konstantinos N.
背景资料：报告脓毒性关节炎的发病率后，前交叉韧带（ACL）重建和管理这一并发症使用一个特定的治疗protocol.Methods：在我们的机构之间进行的所有主要ACL重建2002年1月至2014年1月纳入本研究。对所有感染患者的发病时间、临床症状和培养结果进行分析。根据我们的方案，在诊断感染后立即进行关节镜下清创和膝关节冲洗。在复发的情况下，使用硬件进行膝关节冲洗，取出移植物，然后重新植入。采用Lysholm膝关节评分、国际膝关节文献委员会（IKDC）表格、KT 1000关节测量仪和X线片评价患者。初次关节镜清创后，7例中有6例（85%）感染复发。在这些患者中进行了移植物和硬件移除。4例患者在感染后平均5个月进行了移植物再植入。在最终随访（平均6.3年）时，所有患者均获得全活动度，而在移植物再植入患者中，平均Lysholm评分为92，平均IKDC评分为87。X线片显示，三名患者有正常的膝盖和一名患者有一个等级，膝关节炎根据Kelly-Lawrence classification.Conclusions：ACL重建后的化脓性关节炎的管理，使用特定的手术方案，其中包括移植物取出感染复发的情况下，后来重新植入，可以提供良好的和优秀的结果。证据等级：IV级，病例系列。(C)2017爱思唯尔B.V.保留所有权利。
Background: To report the incidence of septic arthritis after anterior cruciate ligament (ACL) reconstruction and management of this complication using a specific treatment protocol.Methods: All primary ACL reconstructions performed in our institution between January 2002 and January 2014 were included in this study. Time to presentation, clinical symptoms, and culture results of all infected patients were analyzed. According to our protocol, an arthroscopic debridement and irrigation of the knee joint was performed immediately after a diagnosis of infection was made. In case of recurrence, knee irrigation with hardware and graft removal and later re-implantation was performed. Patients were evaluated with the Lysholm knee score, International Knee Documentation Committee (IKDC) Form, KT 1000 arthrometer and radiographic evaluation.Results: Postoperative septic arthritis occurred in seven of 1242 patients (0.56%). After initial arthroscopic debridement, infection recurred in six out of seven cases (85%). Graft and hardware removal was performed in these patients. Graft re-implantation was performed in four patients at an average five months after infection. At the final follow-up (mean 6.3 years) all patients had full range of motion, while in patients with graft re-implantation the mean Lysholm score was 92, and the mean IKDC score was 87. Radiographs demonstrated that three patients had normal knees and one patient had a grade one, knee arthritis according to Kellgren-Lawrence classification.Conclusions: Management of septic arthritis after ACL reconstruction using a specific surgical protocol which includes graft removal in case of infection recurrence with later re-implantation, can provide good and excellent results. Level of evidence: Level IV, case series. (C) 2017 Elsevier B.V. All rights reserved.