Septic arthritis following anterior cruciate ligament reconstruction (ACLR) is a rare and serious complication. Previous studies have shown that septic arthritis is associated with inferior outcome of ACLR. Despite that, there is no standardized treatment protocol, and the course of the disease has mainly been studied within single institutions with a small number of patients. The aim of the present study is to describe the course of septic arthritis following ACLR in a large nationwide cohort. The hypothesis was that the clinical presentation of septic arthritis following ACLR varies according to the infectious agent. The present cohort represents patients with septic arthritis identified in a previous study that analyzed compensation claims reported to the Swedish national insurance company (Löf) in 2005–2014 (1). The diagnosis was confirmed by medical experts at Löf after review of medical records. We conducted a comprehensive analysis of the medical records as well as data available from the Swedish National Knee Ligament Registry (SNKLR) for the study group. The study involved 158 patients who received compensation due to developing septic arhtirits. 94 (59.9%) patients were infected with Coagulase negative staphylococci (CoNS), and 25 patients by Staphyolococcus Aureus (S.Aureus) (15.9%). There was a significant difference between the groups regarding Maximum CRP (p<0.001), and duration between ACLR and first washout operation (p<0.005). S.aureus group had the higest maximum CRP (281) and the shortest duration between ACLR and first washout operation (12 days). The Clinical presentation of septic arthritis following ACLR can vary according to the agent causing the infection, and low virulent agents are responsible for the majority of the infections. Clinicians need to be aware of these differences and consider them when making diagnosis or treatment decisions.
It has been suggested that excessive tibial rotation during pivoting tasks is not controlled by single bundle ACL reconstruction (ACLR). This may be partly explained by graft orientation in the coronal plane. The purpose of this study was to assess tibial rotation after ACLR with an obliquely placed hamstring graft. 18 patients were evaluated. All patients had undergone a primary ACLR for an isolated ACL injury within 6 months of injury. All had a 4 strand graft, either semi-tendinosus alone (ST) or semitendinosus and gracilis (STGR) – 9 in each group, each with 2 females and 7 males. Follow-up was at least 2 years postoperatively and all patients had made a good functional recovery and returned to their pre-injury sporting activities. Evaluation consisted of IKDC 2000, instrumented laxity testing, and 3D motion analysis to record tibial rotation when subjects descended stairs and pivoted 90 degrees on landing using a similar protocol to one which has previously been reported. All patients had made an excellent recovery (mean IKDC score 100 for both groups) and there were no significant differences between the ST and STGR subjects for any of the background variables including anterior knee laxity. There were no differences in the maximal tibial rotational angle between the operated (mean: 20°, range: 10°– 27°) and non operated limb (mean: 21°, range: 6°– 42°). There was no significant difference between the graft types (ST: 20°, STGR: 21°). Females had greater tibial rotation on both the operated and non-operated sides compared to males. Contrary to previous reports, we found restoration of normal tibial rotation during the pivoting task after a single bundle ACLR. The lack of difference between the ST and STGR groups suggests that this restoration of normal tibial rotation is due to static rather than dynamic restraints. We suggest that it probably reflects the more horizontal graft orientation in the coronal plane for patients in the current study compared to that reported in previous studies.
