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Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction : A Nationwide Analysis of 26,014 ACL Reconstructions

Kraus Schmitz, Jesper LU orcid ; Lindgren, Viktor ; Edman, Gunnar ; Janarv, Per Mats ; Forssblad, Magnus and Stålman, Anders (2021) In American Journal of Sports Medicine 49(7). p.1769-1776
Abstract

Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National... (More)

Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. Results: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). Conclusion: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ACL reconstruction, incidence, infection, risk factors, septic arthritis
in
American Journal of Sports Medicine
volume
49
issue
7
pages
1769 - 1776
publisher
SAGE Publications
external identifiers
  • pmid:33764802
  • scopus:85103135640
ISSN
0363-5465
DOI
10.1177/0363546521993812
language
English
LU publication?
no
additional info
Publisher Copyright: © 2021 The Author(s).
id
a0bcb96c-c2f3-499b-9a11-d0b23c75fe72
date added to LUP
2022-09-11 20:04:32
date last changed
2024-06-13 15:05:12
@article{a0bcb96c-c2f3-499b-9a11-d0b23c75fe72,
  abstract     = {{<p>Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. Results: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). Conclusion: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).</p>}},
  author       = {{Kraus Schmitz, Jesper and Lindgren, Viktor and Edman, Gunnar and Janarv, Per Mats and Forssblad, Magnus and Stålman, Anders}},
  issn         = {{0363-5465}},
  keywords     = {{ACL reconstruction; incidence; infection; risk factors; septic arthritis}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{1769--1776}},
  publisher    = {{SAGE Publications}},
  series       = {{American Journal of Sports Medicine}},
  title        = {{Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction : A Nationwide Analysis of 26,014 ACL Reconstructions}},
  url          = {{http://dx.doi.org/10.1177/0363546521993812}},
  doi          = {{10.1177/0363546521993812}},
  volume       = {{49}},
  year         = {{2021}},
}