Wang Cheng, Lee Yee Han Dave, Siebold Rainer
Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.
Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2136-44. doi: 10.1007/s00167-013-2648-z. Epub 2013 Sep 6.
To evaluate the current evidence for the management of septic arthritis after anterior cruciate ligament (ACL) reconstruction, the factors that affect the outcome after treatment and the retention of graft and implants.
A systematic literature search of the PubMed database was performed on septic arthritis after ACL reconstruction. A total of 301 publications were initially identified, and 17 papers were found to fulfil the criteria to be included in the review.
There were 196 cases of septic arthritis after ACL reconstruction in over 30,000 ACL reconstructions, making the proportion of infection 0.6%. Most patients (114/123, 92.6%) had an acute or subacute infection at an average of 16.8 ± 10.5 days after ACL reconstruction. Coagulase-negative Staphylococci (CNS) was the most common organism (67/147, 45.6%) followed by Staphylococcus aureus (SA) (35/147, 23.8%); 86.9% underwent surgical treatment of which 92.8% had an average of 1.54 (up to 4) arthroscopic debridements. The group with SA infection had a higher graft removal rate (33.3%, p = 0.019), a longer antibiotic duration (35.4 days, p = 0.047) and a worse range of flexion (111.5°, p = 0.036) than the CNS group.
CNS was the most common organism in septic arthritis after ACL reconstruction followed by SA. For most authors, arthroscopic debridement combined with intravenous antibiotic therapy was the initial treatment of choice. Antibiotic therapy with or without multiple irrigations of the joint is not recommended based on the high failure rates. Delayed diagnosis of more than 7 days or SA infection required a longer duration of antibiotic therapy and increased the likelihood for graft removal and restricted range of motion. Fungal infection and tubercular infection had a high prevalence of late diagnosis and open debridement.
Systematic review, Level IV.
评估目前关于前交叉韧带（ACL）重建术后感染性关节炎的治疗证据、影响治疗后结果的因素以及移植物和植入物的留存情况。
对PubMed数据库进行系统文献检索，查找ACL重建术后感染性关节炎的相关内容。最初共识别出301篇出版物，其中17篇符合纳入本综述的标准。
在超过30,000例ACL重建手术中，有196例发生了ACL重建术后感染性关节炎，感染比例为0.6%。大多数患者（114/123，92.6%）在ACL重建术后平均16.8±10.5天出现急性或亚急性感染。凝固酶阴性葡萄球菌（CNS）是最常见的病原体（67/147，45.6%），其次是金黄色葡萄球菌（SA）（35/147，23.8%）；86.9%的患者接受了手术治疗，其中92.8%的患者平均接受了1.54次（最多4次）关节镜下清创术。与CNS组相比，SA感染组的移植物移除率更高（33.3%，p = 0.019），抗生素使用时间更长（35.4天，p = 0.047），屈曲范围更差（111.5°，p = 0.036）。
CNS是ACL重建术后感染性关节炎中最常见的病原体，其次是SA。对于大多数作者而言，关节镜下清创术联合静脉抗生素治疗是首选的初始治疗方法。基于高失败率，不建议单独使用抗生素治疗或联合多次关节冲洗。诊断延迟超过7天或SA感染需要更长时间的抗生素治疗，并增加了移植物移除的可能性以及限制了活动范围。真菌感染和结核感染的晚期诊断和开放清创的发生率较高。
系统评价，IV级。
Zotero 插件