Concerns About Management of Septic Arthritis After ACL Reconstruction
2009; Elsevier BV; Volume: 25; Issue: 9 Linguagem: Inglês
10.1016/j.arthro.2009.06.012
ISSN1526-3231
Autores Tópico(s)Total Knee Arthroplasty Outcomes
ResumoI have serious concerns about the article “Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of Incidence, Presentation, Treatment, and Cause” by Wang et al.1Wang C. Ao Y. Wang J. Hu Y. Cui G. Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: A retrospective analysis of incidence, presentation, treatment, and cause.Arthroscopy. 2009; 25: 243-249Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar They report on 21 patients with a postoperative infection, and yet only 16 patients had positive cultures. Of the 21 patients, 6 were treated by simple arthrocentesis and irrigation. I think this is very worrisome to present as a potential treatment for an infected ACL reconstruction. In my opinion, this would clearly be below the standard of care. The authors also state that IV antibiotics were only continued for a mean period of 19.4 days. For some of these serious infections with serious potential complications, this seems like an inordinately short period of time for the IV antibiotics. The authors state that patients were changed to oral antibiotics as soon as the C-reactive protein level was normalized, but this seems like a very rapid time to normalize, particularly in the face of patients who potentially only had an aspiration of their knee. The authors state that the symptoms of infection stabilized at a mean of 3.8 days. These data are highly contrary to almost all published cases of ACL infection where, many times, multiple procedures, and lengthy hospitalizations, are required to stabilize symptoms of infection. In fact, the authors state that the symptoms of infection stabilized within a range of 0 to 22 days. It seems hard to imagine that symptoms of infection could stabilize on day 0. Lastly, the authors, in their title, discuss their treatment for this septic arthritis. However, there are no results in the article on postoperative range of motion, some sort of standardized knee score, radiographic follow-up, and so on. How can judgments be made that treatment was effective when no results are listed? ACL infection is a serious issue that many times is very complex and difficult to treat. I think to list a series of patients where some have simple knee aspiration and irrigation and the rest have an arthroscopic debridement only and a short term of IV antibiotics and then to indicate that most patients have stabilization of symptoms within just a few days can be misleading. Finally, the authors state that they lacked experience with septic arthritis and that is why the early patients were treated with aspiration. They state that they realized that there were problems with conservative treatment. However, in their article there do not appear to be any problems with this conservative treatment because all patients apparently have done well and the aspiration seemed to be effective in the patients who received this treatment. The only difference was a longer recovery time of 9.2 days compared with 1.5 days and the use of IV antibiotics for 28 days versus 19 days. It is hard to believe that all patients treated by an arthroscopic debridement had recovered by a mean of 1.5 days after debridement. It is surprising that all knees treated by aspiration, graft retention, and short-term antibiotics did well. Author's ReplyArthroscopyVol. 25Issue 9PreviewI thank Dr. Burks for his kindly interest in our study. This retrospective study on septic arthritis after anterior cruciate ligament reconstruction (ACLR) was based on the clinical data of the 4,068 cases of ACLR in our institution from 1997 to 2007. The objective of our study was to summarize and analyze our experience in the hope that it could provide some useful opinions for all orthopaedic surgeons. Full-Text PDF
Referência(s)