IOA 2022

Factors Associated with Intra-articular Infection following Anterior Cruciate Ligament Reconstruction – Graft Choice Matters

Niv Marom 1 Milan Kapadia 2 Joseph Nguyen 2 Caroline Boyle 2 Brittany Ammerman 2 Jo Hannafin 2 Robert Marx 2 Anil Ranawat 2
1Department of Orthopaedic Surgery, Meir Medical Center, Israel
2Sports Medicine Institute, Hospital for Special Surgery, USA

Background:
Intra-articular infection after Anterior Cruciate Ligament reconstruction (ACLR) is a rare complication, but one with potentially devastating consequences. The rare nature of this complication raises difficulties in detecting risk factors associated with it and with worse outcomes after an infection occurred.

Purpose:
The purposes of this study were (1) to evaluate the association between infection after ACLR and potential risk factors in a large, single center cohort of ACLR patients and (2) to assess factors associated with ACL graft retention versus removal.

Methods:
All ACL reconstructions performed at our institution between January 2010 and December 2018 were reviewed; 11,451 total procedures were identified. A retrospective medical record review was performed to determine the incidence of infection, patient and procedure characteristics associated with infection, infection characteristics, incidence of ACL graft retention and factors associated with retention versus removal of the ACL graft. Multivariable logistic regression analysis was used to identify potential risk factors for infection following ACLR.

Results:
Of the 11,451 ACL reconstructions, forty-eight infections were identified (0.42%). Multivariable logistic regression analysis revealed ACLR revision cases (odds ratio [OR]=3.13; confidence interval [CI]=1.55 to 6.3; p=0.001) and younger age (OR=1.06; 95% CI=1.02 to 1.1; p=0.001) as risk factors for infection. Compared with bone-patellar tendon-bone (BPTB) autograft, both hamstring autograft and allografts were independently associated with increased the risk of infection (OR=4.39; 95% CI=2.15 to 8.96; p

Conclusion:
In a large, single center, cohort of ACLR patients and infected ACLR patients, revision cases and younger patients have a higher incidence of infection. The use of BPTB autograft is associated with a lowest risk of infection after ACLR, compared with both hamstrings autografts and allografts. Larger cohorts with a greater number of infected ACLR cases are needed to determine factors associated with graft retention versus removal.