Current Paper of the week

Current Paper of the week

  • Paper of the Week: Factors Associated With an Intra-articular Infection After Anterior Cruciate Ligament Reconstruction: A Large Single-Institution Cohort Study

    Niv Marom, MD , Milan Kapadia, BS, Joseph T. Nguyen, MPH , Brittany Ammerman, MBS, Isabel Wolfe, BS, Kristin C. Halvorsen, BS, Andy O. Miller, MD, Michael W. Henry, MD , Barry D. Brause, MD, Jo A. Hannafin, MD, Robert G. Marx, MD, and Anil S. Ranawat, MD

    Summary by Carlo Coladonato, MS

    Septic arthritis following anterior cruciate ligament reconstruction is a rare complication with reports ranging from 0.12-1%.1–3 Despite its low reported incidence, the frequency of ACLR indicates that a large number of patients are affected. While there have been ample attempts to investigate factors that increase the risk for infection, the relatively low incidence has led to a paucity of conclusive evidence within the orthopaedic literature.

    The purpose of this study was therefore to evaluate the association between an infection
    after ACLR and potential risk factors in a large single-center cohort of patients who had
    undergone ACLR. A total of 11,451 ACLR cases were identified at a single institution between
    January 2010 and December 2018. All patients confirmed to have deep tissue infection as
    defined by the National Healthcare Safety Network/Center for Disease Control and Prevention
    guidelines for deep tissue infections.

    Overall, 0.42% of the cohort obtained a post-operative infection. There were significant
    differences in patient age (26.0 ± 12.0 vs 30.0 ± 12.3 years, respectively; P = .023) and graft type
    (P = .005) used between infection cases and non-infection cases. There was no significant
    difference found for BMI, smoking history, or Elixhauser Comorbidity Index. In the
    multivariable logistic regression model for the risk of infections after ACLR, revision surgery

    (OR, 3.13 [95% CI, 1.55-6.32]; P = .001), allografts compared with bone-patellar tendon-bone
    (BPTB) autografts (OR, 5.27 [95% CI, 1.81-15.35]; P = .002), and hamstring tendon autografts
    compared with BPTB autografts (OR, 4.39 [95% CI, 2.15-8.96]; P < .001) increased the risk of
    infections. Younger age was found to be associated with an infection (OR, 1.06 [95% CI, 1.02-
    1.10]), with every year increase in age associated with a decreased likelihood of infections (OR,
    0.94 [95% CI, 0.91-0.98]; P = .001).

    There are many factors that may influence the risk of septic arthritis following ACLR,
    including graft preparation, surgical technique, graft type as well as patient characteristics. 1 The
    current study illustrates the importance of these risk factors and can enhance surgeon decision-
    making. Despite the overall low incidence of infections after ACLR, the considerably lower risk
    of infections with the use of BPTB autografts, compared with both hamstring tendon autografts
    and allografts, is clinically relevant.
    The results of the current study also suggests revision ACLR and younger age may also be
    associated with a higher infection rate. 2,4–6


    1. Bansal A, Lamplot JD, VandenBerg J, Brophy RH. Meta-analysis of the Risk of Infections
      After Anterior Cruciate Ligament Reconstruction by Graft Type. Am J Sports Med.
      2018;46(6):1500-1508. doi:10.1177/0363546517714450
    2. Brophy RH, Wright RW, Huston LJ, Nwosu SK, MOON Knee Group, Spindler KP. Factors
      associated with infection following anterior cruciate ligament reconstruction. J Bone Joint
      Surg Am.
      2015;97(6):450-454. doi:10.2106/JBJS.N.00694
    3. Gobbi A, Karnatzikos G, Chaurasia S, Abhishek M, Bulgherhoni E, Lane J. Postoperative
      Infection After Anterior Cruciate Ligament Reconstruction. Sports Health. 2016;8(2):187-doi:10.1177/1941738115618638
    4. Kuršumović K, Charalambous CP. Relationship of Graft Type and Vancomycin Presoaking to
      Rate of Infection in Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of 198
      Studies with 68,453 Grafts. JBJS Rev. 2020;8(7):e1900156. doi:10.2106/JBJS.RVW.19.00156
    5. Ju B, Mc D, Tg M, Rf W, Rj W, Aa A. Effect of graft selection on the incidence of
      postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med.
      2010;38(2). doi:10.1177/0363546509346414
    6. Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft compared with
      autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint
      Surg Am.
      2010;92(14):2402-2408. doi:10.2106/JBJS.I.00456
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