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Infection After ACL Reconstruction

Infection After ACL Reconstruction. H. Makhmalbaf MD Consultant Orth.& Knee Surgeon Mashhad University of Medical Sciences. Prevention:. Patient selection : phenotype, BMI Environment, surgical technique, experience Timing of surgery, duration of operation Antibiotic prophylaxis

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Infection After ACL Reconstruction

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  1. Infection After ACL Reconstruction H. Makhmalbaf MD Consultant Orth.& Knee Surgeon Mashhad University of Medical Sciences

  2. Prevention: • Patient selection: phenotype, BMI • Environment, surgical technique, experience • Timing of surgery, duration of operation • Antibiotic prophylaxis • Type of graft, sterilization method, instrument • Fixation materials, Bio absorbable or metallic

  3. Risk factors • Previous surgery • Revision ACL surgery • Presence of metal-works • Simultaneous procedures: PCL rec. osteotomy • Type of graft, sterilization method, instrument • Implants used • Synthetic ligaments

  4. Foreign body in the Joint

  5. Chondrolysis & OA

  6. Infection after ACL • Superficial or deep infection • Clinical findings • Synovial fluid analysis • Laboratory findings • Imaging: X-ray, MRI

  7. Synthetic Ligament

  8. Treatment options • IV Antibiotics • Arthroscopic washout & debridement • Open arthrotomy with preservation of graft • Arthrotomy and removal of graft & fixation material

  9. Outcome of infection • Reoperations, hospitalization, costs, job loss • Pain, limitation of ROM, scars • Wasted quads, longer rehab period • Graft jeopardy or failure • Loss of playing season or athletic career

  10. Conclusion • Stick to the principles • Patient selection • Clean operative environment • Operative technique, instruments • Graft selection & sterility • Iv antibiotics • Close observation & prompt intervention

  11. Operative environment

  12. Infection Following Arthroscopic Anterior Cruciate ReconstructionMAJ Daniel Judd et al.Arthroscopy J. April 2006

  13. Purpose of study: • Review their cases & other reports to identify • Risk factors • Evaluate physical & lab. Findings • Compare different treatments & • Assess clinical outcomes

  14. Results : • Retrospective study 1994- 2002 • 11 infections in 1615 pts. • Hamstring autograft, previous knee surgery • & Acl reconstructions • TibialAcl graft fixation with a post & washer • Associated with increased infection

  15. The goals of treatment are • To protect the articular cartilage • To protect the graft • Timely initiation of treatment including • Joint lavage, debridement & antibiotics • Are essential to treatment • Graft & hardware retention is possible • Expedient graft & hardware removal

  16. Septic Arthritis After Arthroscopic ACL Reconstruction, Wang C 2009Arthroscopy J

  17. Diagnosis & treatment of septic arthritis • 1997-2007, 21pts. Out of 4068 • The most common symptoms were: • Fever, swelling, severe pain, tenderness & • Restricted motion • ESR, CRP &Fibrinogen levels markedly elevated

  18. Septic arthritis after • Coagulase-neg. Staph was the most common • Both conservative & 0perative treatment were effective • Longer recovery time and IV antibiotic therapy in the conservative group

  19. Conclusion: • Septic arthritis is rare but potentially devastating complication • Correct diagnosis relies on: • Clinical evaluation, Lab tests • Synovial fluid analysis & bacterial culture • Early diagnosis & prompt treatment • Arthroscopic debridement & irrigation & • Retention of ACL graft when still functional

  20. Autograft contamination during preparation for ACL reconstructionMichael E Hantes, MD et al JBJS Am 2008

  21. Comments : • BPB & Hamstring Autografts most commonly • Graft contamination during preparation • By surgical masks, gloves & instruments • Contamination of graft could be a risk factor • In septic arthritis ESR & CRP are elevated

  22. Aim of study: • Chance of graft contamination • Association between contamination & infec. • Chance of contamination of BPB & Hamstring • Contamination & inflammatory blood markers • 30 pts. In each group • 3 specimens for culture • ESR & CRP checked preop. & 3, 7,20 days post

  23. Results: • A high rate of contamination (12%) • Contamination rate was equal in two grafts • No association between contamination & elevation of ESR, CRP • More positive cultures in 2nd & 3rd specimens • Slight elevation of ESR & CRP in all pts. • No association between graft cont. & infection

  24. Previous UTO:

  25. Previous UTO:

  26. MRI of the Knee

  27. After ACL reconstruction:

  28. We have to be careful

  29. Thank you

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