Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, Michigan, U.S.A.; Mid-Michigan Orthopaedic Institute, East Lansing, Michigan, U.S.A..
Department of Osteopathic Surgical Specialties, Michigan State University, East Lansing, Michigan, U.S.A.; Mid-Michigan Orthopaedic Institute, East Lansing, Michigan, U.S.A.
Arthroscopy. 2014 Jun;30(6):747-54. doi: 10.1016/j.arthro.2014.02.015. Epub 2014 Mar 27.
To systematically review the literature and characterize the success and failure rates of arthroscopic irrigation and debridement (I & D) in the treatment of septic arthritis after anterior cruciate ligament (ACL) reconstructions. We also aimed to identify which variables affected the failure rate.
Five databases (MEDLINE, Ovid, Medscape, Web of Science, and Google Scholar) were screened for clinical studies involving the treatment of septic arthritis after ACL reconstruction with arthroscopic I & D. A full-text review of eligible studies was conducted. Inclusion and exclusion criteria were applied to the searched studies. Failure of I & D was defined as the need for graft removal or revision ACL reconstructive surgery because of infection. Data from the selected studies were combined for statistical analyses to elucidate factors associated with the success or failure.
We identified 11 eligible studies involving 90 patients. These studies described the results of 90 arthroscopic I & D procedures with an overall success rate of 85.6%. Repeated I & D was necessary in 34.5% of patients. Removal of the graft with or without subsequent revision ACL reconstruction was reported in 13 (14.4%) cases. Statistical analysis showed that cases involving Staphylococcus aureus (P = .053), 2 or more I & D procedures (P = .029), and allografts (P < .0001) were at greater risk of failure.
Arthroscopic I & D with graft retention is an effective treatment for patients with septic arthritis after ACL reconstruction. Factors affecting the failure rate may include graft choice and organism virulence.
Level IV, systematic review of Level IV studies.
系统回顾文献，分析关节镜灌洗和清创术（I&D）治疗前交叉韧带（ACL）重建后化脓性关节炎的成功率和失败率，并确定哪些变量会影响失败率。
在 MEDLINE、Ovid、Medscape、Web of Science 和 Google Scholar 这 5 个数据库中筛选了关于 ACL 重建后化脓性关节炎采用关节镜 I&D 治疗的临床研究。对符合条件的研究进行了全文审查。应用纳入和排除标准对检索到的研究进行筛选。I&D 失败定义为需要因感染而移除移植物或进行 ACL 翻修重建手术。对选定研究的数据进行合并，进行统计学分析，以阐明与成功或失败相关的因素。
我们确定了 11 项符合条件的研究，共涉及 90 例患者。这些研究描述了 90 例关节镜 I&D 手术的结果，总成功率为 85.6%。34.5%的患者需要重复 I&D。13 例（14.4%）患者报告了移植物的移除，或随后进行了 ACL 翻修重建。统计分析显示，金黄色葡萄球菌感染（P =.053）、2 次或以上 I&D 手术（P =.029）以及同种异体移植物（P <.0001）的病例更有可能失败。
保留移植物的关节镜 I&D 是治疗 ACL 重建后化脓性关节炎的有效方法。影响失败率的因素可能包括移植物的选择和病原体的毒力。
IV 级，对 IV 级研究的系统评价。
