Matava M J, Evans T A, Wright R W, Shively R A
Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri, USA.
Arthroscopy. 1998 Oct;14(7):717-25. doi: 10.1016/s0749-8063(98)70098-2.
To determine the incidence of joint sepsis following anterior cruciate ligament (ACL) reconstruction and the prevailing attitudes toward its treatment, we surveyed the directors of Sports Medicine Fellowship programs about their practices in treating and preventing this complication. Of the 74 surgeons surveyed, 61 (82%) responded. These 61 surgeons performed an average of 98 ACL reconstructions yearly; 31 (51 %) routinely used a drain after ACL surgery, 18 (30%) had treated an ACL infection within the past 2 years, and 26 (43%) had treated an infection within the past 5 years. There was no significant difference in the number of infections and the surgeons' case load, graft choice, or method of reconstruction. Fifty-two surgeons (85%) selected culture-specific intravenous (IV) antibiotics and surgical irrigation of the joint with graft retention as initial treatment for the infected patellar tendon autograft, and 39 (64%) chose this regimen to treat the infected allograft. For the resistant infection unresponsive to initial treatment, IV antibiotics with surgical irrigation and graft retention were also selected as the most common treatment combination for 25 (39%) of the 61 respondents. After graft removal, the earliest a revision procedure would be considered was 6 to 9 months. The results of this survey confirm the widely held belief that septic arthritis of the knee is a relatively rare complication following ACL reconstruction. Once an infection is encountered, culture-specific IV antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft excision and hardware removal is considered only for those infections resistant to initial treatment and for the infected allograft.
为了确定前交叉韧带（ACL）重建术后关节感染的发生率及其普遍的治疗态度，我们就治疗和预防这种并发症的做法，对运动医学 fellowship 项目的负责人进行了调查。在接受调查的 74 位外科医生中，61 位（82%）做出了回应。这 61 位外科医生每年平均进行 98 例 ACL 重建手术；31 位（51%）在 ACL 手术后常规使用引流管，18 位（30%）在过去 2 年内治疗过 ACL 感染，26 位（43%）在过去 5 年内治疗过感染。感染数量与外科医生的病例量、移植物选择或重建方法之间没有显著差异。52 位外科医生（85%）选择针对特定培养物的静脉内（IV）抗生素以及保留移植物的关节手术冲洗作为感染髌腱自体移植物的初始治疗方法，39 位（64%）选择这种方案来治疗感染的同种异体移植物。对于对初始治疗无反应的耐药感染，在 61 位受访者中有 25 位（39%）也选择静脉内抗生素联合手术冲洗并保留移植物作为最常见的治疗组合。移植物移除后，最早考虑进行翻修手术的时间是 6 至 9 个月。这项调查的结果证实了人们普遍持有的观点，即膝关节化脓性关节炎是 ACL 重建术后相对罕见的并发症。一旦遇到感染，建议将针对特定培养物的静脉内抗生素和保留移植物的手术关节冲洗作为初始治疗。仅对于那些对初始治疗耐药的感染以及感染的同种异体移植物才考虑进行移植物切除和内固定取出。
