Meglic Uros, Salapura Vladka, Zupanc Oskar
Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Orthop J Sports Med. 2021 Nov 2;9(11):23259671211052519. doi: 10.1177/23259671211052519. eCollection 2021 Nov.
Although a rare complication, septic arthritis (SA) after anterior cruciate ligament (ACL) reconstruction has potentially devastating consequences for the knee joint.
To prospectively analyze, at a mean 4-year follow-up, subjective, clinical, radiographic, and magnetic resonance imaging (MRI) findings between patients with SA and those with no septic complication after ACL reconstruction.
Cohort study; Level of evidence, 2.
Of 2006 ACL reconstructions performed between 2004 and 2014, a total of 20 patients experienced SA. All patients were treated with arthroscopic irrigation and graft-retaining debridement immediately after diagnosis and at least 6 weeks of antibiotic treatment. After the exclusion process, 18 patients were included in the SA group and 20 in the control group. At final follow-up at a mean 48 months, a physical examination, KT-1000 arthrometer laxity test, Lysholm knee score, Tegner activity score, and International Knee Documentation Committee radiographic score were completed and then compared with preoperative data. The Boston-Leeds Osteoarthritis Knee Score was used for MRI evaluation at final follow-up to note chondral changes.
No significant differences between the SA and control groups were observed in pre- and perioperative variables that could indicate a higher incidence of early osteoarthritis (OA). Although range of motion and knee stability were not significantly different between the groups at final follow-up, the Lysholm score (mean ± SD, 79.8 ± 13.1 vs 90.9 ± 8.6; < .01) and Tegner score (6.0 ± 1.1 vs 7.0 ± 1.4; = .03) were significantly lower in the SA group as compared with the control group. MRI evaluation at final follow-up demonstrated a significantly higher degree of early knee OA in the SA group versus the control group. However, no differences in the degree of OA were seen on plain radiographs at final follow-up between the groups.
MRI evaluation provided signs of worsened chondral state in the SA group, which could be associated with reduced functional outcome and return to sports. In contrast to radiograph analyses, MRI was excellent at distinguishing damage to the cartilage and can be useful in early follow-up evaluation of patients with SA after ACL reconstruction.
虽然化脓性关节炎（SA）是前交叉韧带（ACL）重建术后一种罕见的并发症，但对膝关节可能产生灾难性后果。
前瞻性分析在平均4年的随访期内，ACL重建术后发生SA的患者与无感染并发症患者之间的主观、临床、影像学及磁共振成像（MRI）检查结果。
队列研究；证据等级：2级。
在2004年至2014年期间进行的2006例ACL重建手术中，共有20例患者发生SA。所有患者在确诊后立即接受关节镜冲洗和保留移植物的清创术，并接受至少6周的抗生素治疗。经过排除过程，SA组纳入18例患者，对照组纳入20例患者。在平均48个月的最终随访时，完成体格检查、KT-1000关节测角仪松弛度测试、Lysholm膝关节评分、Tegner活动评分以及国际膝关节文献委员会影像学评分，然后与术前数据进行比较。在最终随访时使用波士顿-利兹骨关节炎膝关节评分进行MRI评估，以记录软骨变化。
在术前和围手术期变量方面，SA组和对照组之间未观察到显著差异，这些变量可能表明早期骨关节炎（OA）的发生率较高。虽然在最终随访时两组之间的活动范围和膝关节稳定性无显著差异，但SA组的Lysholm评分（平均值±标准差，79.8±13.1对90.9±8.6；P<.01）和Tegner评分（6.0±1.1对7.0±1.4；P = .03）显著低于对照组。最终随访时的MRI评估显示，SA组早期膝关节OA的程度明显高于对照组。然而，在最终随访时，两组之间的X线平片上OA程度无差异。
MRI评估显示SA组软骨状态恶化的迹象，这可能与功能结果降低和恢复运动有关。与X线片分析不同，MRI在区分软骨损伤方面表现出色，可用于ACL重建术后SA患者的早期随访评估。
