Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Comparative Study of Pediatric, Adolescent, and Young Adult Populations.

IF 2.4 3区 医学 Q2 ORTHOPEDICS
Orthopaedic Journal of Sports Medicine Pub Date : 2025-06-09 eCollection Date: 2025-06-01 DOI:10.1177/23259671251334591
Deepak Chona, Jeffrey Kay, Nazgol Tavabi, Michael Quinn, Dennis Kramer, Yi-Meng Yen, Melissa Ann Christino, Matthew Milewski, Mininder S Kocher, James Pruneski, Ata Kiapour, Benton E Heyworth
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Abstract

Background: Limited evidence exists regarding septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients.

Purpose/hypothesis: The purpose of this study was to compare post-ACLR SA cases during a 21-year period in pediatric and adolescent patients to those in a young adult control cohort. It was hypothesized that the incidence would be similarly low in both subpopulations.

Study design: Case series; Level of evidence, 4.

Methods: Records of patients who underwent ACLR between 2000 and 2020 were retrospectively reviewed for diagnoses of postoperative SA of the ipsilateral knee, defined by culture-positive arthrocentesis or synovial fluid white blood cell count >50,000 cells/mL. Surgical details, culture results, and clinical course were analyzed. Age-based cohorts-pediatric (<13 years of age), adolescent (13-19 years of age), and young adult (20-35 years of age)-were compared using chi-square tests for age, graft source, graft type, concurrent meniscal procedures, and SA incidence. Time between ACLR and subsequent surgeries was analyzed utilizing t tests.

Results: Of 5638 ACLR cases (pediatric: n = 606, 10.7%; adolescent: n = 4123, 73.1%; young adult: n = 909, 16.1%), SA was diagnosed in 13 patients (0.23%; adolescent: n = 12, 0.30%; young adult: n = 1, 0.11%) a median of 15 days (range 6-632 days) after ACLR. One or more arthroscopic irrigation and debridement (I&Ds) (mean, 2; range, 1-3) were performed, and anterior cruciate ligament (ACL) grafts were retained for all patients. The mean clinical follow-up was 3.5 years (range, 0.6-9.2 years). Subsequent surgeries include 2 lysis of adhesions, 3 meniscectomies, 1 meniscal repair, 3 patellar chondroplasties, 1 loose-body removal, 2 patellar biopsies, 1 debridement, and 1 revision ACLR 6 years postoperatively for acute ACL graft rupture. The most common microbes were Staphylococcus aureus (n = 3; 23.1%) and other forms of Staphylococcus species (n = 9; 69.2%). No significant associations were identified between age-based cohort and graft source, graft type, age, or concurrent meniscal surgery.

Conclusion: Post-ACLR SA was similarly rare for adolescents and young adults, and no cases were identified in 606 pediatric patients. No associations were identified between SA and demographic factors, graft source, graft type, or concurrent meniscal surgery. Staphylococcus species were identified in most cases. Aggressive initial surgical treatment with multiple I&Ds was associated with graft retention, with no disproportionate subsequent graft rupture risk.

前交叉韧带重建后脓毒性关节炎:儿童、青少年和年轻成人人群的比较研究。
背景:关于儿童和青少年前交叉韧带重建(ACLR)后脓毒性关节炎(SA)的证据有限。目的/假设:本研究的目的是比较21年间aclr术后儿童和青少年患者与年轻成人对照队列患者的SA病例。据推测,这两个亚群的发病率都很低。研究设计:病例系列;证据等级,4级。方法:回顾性分析2000年至2020年间行ACLR的患者的记录,以诊断同侧膝关节术后SA,其定义为关节积液培养阳性或滑液白细胞计数为500000细胞/mL。分析手术细节、培养结果和临床过程。基于年龄的队列-儿科t检验。结果:5638例ACLR病例(儿童:n = 606, 10.7%;青少年:n = 4123, 73.1%;年轻成人:n = 909, 16.1%), 13例患者被诊断为SA (0.23%;青少年:n = 12, 0.30%;年轻成人:n = 1,0.11%) ACLR后中位15天(范围6-632天)。一次或多次关节镜冲洗和清创(i&d)(平均2次;范围(1-3),所有患者均保留前交叉韧带(ACL)移植物。平均临床随访时间为3.5年(范围0.6-9.2年)。随后的手术包括2例粘连松解术、3例半月板切除术、1例半月板修复术、3例髌骨软骨成形术、1例松体切除术、2例髌骨活检、1例清创术和1例急性前交叉韧带移植破裂术后6年的ACLR翻修术。最常见的微生物是金黄色葡萄球菌(n = 3;23.1%)和其他葡萄球菌种类(n = 9;69.2%)。年龄为基础的队列与移植物来源、移植物类型、年龄或同期半月板手术之间没有明显的关联。结论:aclr后SA在青少年和年轻人中同样罕见,在606例儿科患者中未发现任何病例。未发现SA与人口统计学因素、移植物来源、移植物类型或同期半月板手术有关。在大多数病例中鉴定出葡萄球菌。积极的初始手术治疗合并多次i&d与移植物保留相关,随后移植物破裂的风险没有不成比例。
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来源期刊
Orthopaedic Journal of Sports Medicine
Orthopaedic Journal of Sports Medicine Medicine-Orthopedics and Sports Medicine
CiteScore
4.30
自引率
7.70%
发文量
876
审稿时长
12 weeks
期刊介绍: The Orthopaedic Journal of Sports Medicine (OJSM), developed by the American Orthopaedic Society for Sports Medicine (AOSSM), is a global, peer-reviewed, open access journal that combines the interests of researchers and clinical practitioners across orthopaedic sports medicine, arthroscopy, and knee arthroplasty. Topics include original research in the areas of: -Orthopaedic Sports Medicine, including surgical and nonsurgical treatment of orthopaedic sports injuries -Arthroscopic Surgery (Shoulder/Elbow/Wrist/Hip/Knee/Ankle/Foot) -Relevant translational research -Sports traumatology/epidemiology -Knee and shoulder arthroplasty The OJSM also publishes relevant systematic reviews and meta-analyses. This journal is a member of the Committee on Publication Ethics (COPE).
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