Septic Arthritis Following Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of the Literature


Septic arthritis following anterior cruciate ligament (ACL) reconstruction is an  uncommon but potentially serious complication. The incidence of infection is approximately 0.44%. Staphylococcus and streptococcus strains are the most common infectious pathogens. Infection is typically via direct inoculation. Articular cartilage damage is primarily the result of the unregulated host inflammatory response. The timing of presentation is typically <2 months following surgery. Presenting symptoms commonly mirror normal postoperative findings, making diagnosis difficult. Although laboratory inflammatory markers are often elevated, knee arthrocentesis is the gold standard for diagnosis.  Treatment involves serial arthroscopic or open irrigation and debridement procedures and antibiotic management. Graft retention is often possible, although fixation implants may require removal or exchange. Successful results have been reported following infection eradication in both graft retention and early revision ACL reconstruction scenarios. (Journal of Surgical Orthopaedic Advances 22(2):127–133, 2013)

CPT William F. Scully, MD; MAJ Susan G. Fisher, PA-C; MAJ Stephen A. Parada, MD;
and COL Edward A. Arrington, MD