Bae Ji-Hoon, Lim Hong-Chul, Kim Hak Jun, Kim Taik-Sun, Yang Jae-Hyuk, Yoon Jung-Ro
Department of Orthopedic Surgery, Korea University College of Medicine, Ansan Hospital, Ansan, Korea.
Orthopedics. 2010 Aug 11;33(8). doi: 10.3928/01477447-20100625-24.
We present the 30-month follow-up results of an acute septic arthritis of the knee after meniscal allograft transplantation, which was successfully treated with graft retention. A 21-year-old man presented with a 4-month history of right knee pain following arthroscopic subtotal lateral meniscectomy. Plain radiographs showed there was no arthritic change with neutral limb alignment. Fourteen days after meniscal allograft transplantation, septic arthritis was confirmed with positive cultures for Staphylococcus epidermidis, and arthroscopic debridement and irrigation were performed. The suggested procedures of our treatment regimen include arthroscopic debridement and irrigation with >or=10 L of normal saline as soon as possible after diagnosis or a clinical suspicion is reached, repeated irrigation under the local anesthesia and intravenous antibiotics until clinical symptoms and laboratory results improve. The decision to repeat the debridement was based on clinical and laboratory results. We reevaluated the patients the third or fourth day after every arthroscopic treatment. At last follow-up, 2 years after the final operation, the patient had no clinical sign of infection. Erythrocyte sedimentation rate and C-reactive protein level were normal and plain radiographs indicated no arthritic change. Further the patient had full pain-free range of knee motion. At this time the Lysholm knee score was 89 and the Tegner score was 5. Magnetic resonance imaging 30 months postoperatively revealed slight (3 mm) extrusion without tear. This case is notable because it shows that early aggressive arthroscopic debridement and repeated irrigation with graft retention can be an effective treatment regimen in selected cases.
我们报告了1例半月板同种异体移植术后急性化脓性膝关节炎患者30个月的随访结果，该患者通过保留移植物成功治愈。一名21岁男性在关节镜下外侧半月板次全切除术后4个月出现右膝疼痛。X线平片显示中立位肢体对线时无关节炎改变。半月板同种异体移植术后14天，表皮葡萄球菌培养阳性，确诊为化脓性关节炎，并进行了关节镜下清创和冲洗。我们治疗方案建议的操作包括在诊断或临床怀疑后尽快进行关节镜下清创和用≥10 L生理盐水冲洗，在局部麻醉下重复冲洗并静脉使用抗生素，直至临床症状和实验室检查结果改善。是否重复清创的决定基于临床和实验室检查结果。每次关节镜治疗后第3天或第4天我们对患者进行重新评估。在最后一次手术后2年的最后随访中，患者无感染的临床体征。红细胞沉降率和C反应蛋白水平正常，X线平片显示无关节炎改变。此外，患者膝关节活动范围完全正常且无疼痛。此时，Lysholm膝关节评分为89分，Tegner评分为5分。术后30个月的磁共振成像显示有轻微（3 mm）的移位但无撕裂。该病例值得注意，因为它表明在某些病例中，早期积极的关节镜清创和保留移植物的反复冲洗可能是一种有效的治疗方案。
