Chona Deepak, Kay Jeffrey, Tavabi Nazgol, Quinn Michael, Kramer Dennis, Yen Yi-Meng, Christino Melissa Ann, Milewski Matthew, Kocher Mininder S, Pruneski James, Kiapour Ata, Heyworth Benton E
Boston Children's Hospital, Boston, Massachusetts, USA.
Orthop J Sports Med. 2025 Jun 9;13(6):23259671251334591. doi: 10.1177/23259671251334591. eCollection 2025 Jun.
Limited evidence exists regarding septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) in pediatric and adolescent patients.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare post-ACLR SA cases during a 21-year period in pediatric and adolescent patients to those in a young adult control cohort. It was hypothesized that the incidence would be similarly low in both subpopulations.
Case series; Level of evidence, 4.
Records of patients who underwent ACLR between 2000 and 2020 were retrospectively reviewed for diagnoses of postoperative SA of the ipsilateral knee, defined by culture-positive arthrocentesis or synovial fluid white blood cell count >50,000 cells/mL. Surgical details, culture results, and clinical course were analyzed. Age-based cohorts-pediatric (<13 years of age), adolescent (13-19 years of age), and young adult (20-35 years of age)-were compared using chi-square tests for age, graft source, graft type, concurrent meniscal procedures, and SA incidence. Time between ACLR and subsequent surgeries was analyzed utilizing tests.
Of 5638 ACLR cases (pediatric: n = 606, 10.7%; adolescent: n = 4123, 73.1%; young adult: n = 909, 16.1%), SA was diagnosed in 13 patients (0.23%; adolescent: n = 12, 0.30%; young adult: n = 1, 0.11%) a median of 15 days (range 6-632 days) after ACLR. One or more arthroscopic irrigation and debridement (I&Ds) (mean, 2; range, 1-3) were performed, and anterior cruciate ligament (ACL) grafts were retained for all patients. The mean clinical follow-up was 3.5 years (range, 0.6-9.2 years). Subsequent surgeries include 2 lysis of adhesions, 3 meniscectomies, 1 meniscal repair, 3 patellar chondroplasties, 1 loose-body removal, 2 patellar biopsies, 1 debridement, and 1 revision ACLR 6 years postoperatively for acute ACL graft rupture. The most common microbes were (n = 3; 23.1%) and other forms of species (n = 9; 69.2%). No significant associations were identified between age-based cohort and graft source, graft type, age, or concurrent meniscal surgery.
Post-ACLR SA was similarly rare for adolescents and young adults, and no cases were identified in 606 pediatric patients. No associations were identified between SA and demographic factors, graft source, graft type, or concurrent meniscal surgery. species were identified in most cases. Aggressive initial surgical treatment with multiple I&Ds was associated with graft retention, with no disproportionate subsequent graft rupture risk.
关于儿童和青少年患者前交叉韧带重建（ACLR）术后感染性关节炎（SA）的证据有限。
目的/假设：本研究的目的是比较21年间儿童和青少年患者ACLR术后SA病例与年轻成人对照组的情况。假设两个亚组的发病率同样低。
病例系列；证据等级，4级。
回顾性分析2000年至2020年间接受ACLR患者的记录，以诊断同侧膝关节术后SA，定义为关节穿刺培养阳性或滑液白细胞计数>50,000个/mL。分析手术细节、培养结果和临床过程。使用卡方检验比较基于年龄的队列——儿童（<13岁）、青少年（13 - 19岁）和年轻成人（20 - 35岁）——在年龄、移植物来源、移植物类型、同期半月板手术和SA发病率方面的情况。利用检验分析ACLR与后续手术之间的时间。
在5638例ACLR病例中（儿童：n = 606，10.7%；青少年：n = 4123，73.1%；年轻成人：n = 909，16.1%），13例患者（0.23%；青少年：n = 12，0.30%；年轻成人：n = 1，0.11%）在ACLR术后中位15天（范围6 - 632天）被诊断为SA。进行了一次或多次关节镜冲洗和清创术（I&Ds）（平均2次；范围1 - 3次），所有患者均保留了前交叉韧带（ACL）移植物。平均临床随访时间为3.5年（范围0.6 - 9.2年）。后续手术包括2次粘连松解术、3次半月板切除术、1次半月板修复术、3次髌骨软骨成形术、1次游离体取出术、2次髌骨活检、1次清创术，以及1例术后6年因急性ACL移植物破裂进行的ACL翻修术。最常见的微生物是（n = 3；23.1%）和其他形式的物种（n = 9；69.2%）。在基于年龄的队列与移植物来源、移植物类型、年龄或同期半月板手术之间未发现显著关联。
青少年和年轻成人ACLR术后SA同样罕见，606例儿童患者中未发现病例。在SA与人口统计学因素、移植物来源、移植物类型或同期半月板手术之间未发现关联。大多数病例中鉴定出了物种。多次I&Ds的积极初始手术治疗与移植物保留相关，后续移植物破裂风险无不成比例增加。
