Eradication and graft retention can be achieved in the treatment for acute septic arthritis after primary posterior cruciate ligament reconstruction: analysis of 1561 reconstructions

Abstract

Purpose: Acute septic arthritis after arthroscopic posterior cruciate ligament (PCL) reconstruction is a rare but severe complication. Optimal management has not been established. The purposes of this study were to analyze clinical findings and to retrospectively evaluate the graft-retaining treatment regimen.

Methods: From 2010 to 2021, a total of 1561 primary PCL reconstructions were performed at our institution. Seven patients with septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical manifestations, treatment, postoperative clinical course and follow-up results.

Results: The mean interval from PCL reconstruction to the onset of symptoms was 11.0 ± 4.0 days. Staphylococcus aureus was the most commonly found pathogen. Eradication was achieved in all patients after a mean of 1.1 ± 0.4 procedures, with graft retention in all patients. The mean duration of antibiotic treatment was 5.7 ± 1.5 weeks. At the last follow-up, there was no recurrence, graft insufficiency or osteoarthritis.

Conclusion: Arthroscopic graft-retaining treatment combined with individual antibiotic therapy, eradication and good to excellent functional results can be achieved, which might encourage surgeons to try to retain the graft as much as possible.

Level of evidence: Level IV.

Keywords: Acute septic arthritis; Graft-retaining treatment; Posterior cruciate ligament.