170. THE OTTAWA TREATMENT PROTOCOL FOR SEPTIC ARTHRITIS FOLLOWING ACL RECONSTRUCTION

Abstract

Purpose: To present our clinical and quality of life outcomes after one year treatment with our protocol including graft retention.

Method: Seventeen of 1, 847 patients who underwent ACL reconstruction surgery were identified as infected following retrospective chart review in our institution (University of Ottawa) from 1995 to 2005. Mean age was 37 years old (range 18–56). Gender ratio was 14 male/ three female. Laterality 13 left/ four right knees. The diagnosis was achieved by clinical suspicion and serum markers (ESR, CPR, WBC) followed with aspiration and culture of intraarticular liquid. After that, our treatment protocol included IV antibiotics (empiric and culture guided) and knee arthroscopy performing debridement and lavage with 12L of saline irrigation as well as graft retention when possible. Clinical and Radiographic data were collected at a minimum of one year follow-up (IKDC, KT-1000, Lysholm, SF-12, Tegner, Cybex Strength testing).

Results: The Incidence of septic arthritis following ACL reconstruction was 0, 92%. Bacteriology results were as follows: seven staphylococcus aureus, four Propionibac-terium acnes, one Klebsiella oxytoca, five no growth. The time from ACL reconstruction to first symptoms of infection was 37 days (range 4–63). The time from symptoms to arthroscopic debridement was 5, 5 days (range 0–33). Serology markers were as follows: ESR mean 69 (range 23–128), CPR 136 (50–387), WBC 10.3 (6–15). The average follow up was 41 months (range 12–85). Sixteen of 17 grafts were retained after 1.53 procedures per patient. Antibiotic treatment lasted 5.2 weeks on average. The average clinical outcomes were: Lysholm 77 (44–98), IKDC 74 (46–95), Quadriceps strength 71 % of non operative side, and Hamstrings strength 70 % of non operative side, KT -1000 side to side difference 1 mm (−3 to 4). Degenerative radiological changes were noted in three patients. Two later repeat reconstructions occurred due to instability (11,1%). No delayed recurrence of infection was noted.

Conclusion: ACL reconstruction is a safe procedure being the incidence of septic arthritis in our series of 0, 92%. Our protocol of treatment is clinically effective and allows for a stable knee in 88, 9% of the patients avoiding the appearance of a delayed infection.