Acl Reconstruction Literature Review

Response/Recommendation:

Between 3 to 6 months. As the literature is limited, the exact timing remains at the discretion of the individual surgeon. However, it is considered safe to perform revision ACL reconstruction following treatment for prior infection, at least 6 weeks, and ideally 3 to 6 months following resolution.

Strength of Recommendation: Limited

Rationale:

Infection following ACL reconstruction surgery is rare, with an incidence 0.14% to 2.25%.1,5 When infection does occur, there are potentially significant consequences, particularly regarding patient outcomes.2 Following allograft ACL reconstruction, there is a well-known, rare, risk of disease transmission however, a recent literature review found no difference in infection rates between autograft and allograft ACL reconstructions.3,4

Graft retention following an infected ACL reconstruction is a viable option as a recent meta-analysis and systematic review reported a success rate of 85%.5 Matava et al surveyed 61 orthopaedic surgeons and found that graft removal was no popular as initial treatment, with only 6% and 33% doing this for

reported on 2500 ACL reconstructions with 7 infections: the graft was removed in 4 cases. One of these cases underwent successful revision ACL reconstruction a year later. 10 In a retrospective review of 3500 ACL reconstructions, Indelli et al identified 6 infections treated with arthroscopic debridement of which 2 grafts were removed, culminating in 1 revision ACL reconstruction and 1 total knee arthroplasty (TKA) a year later.11 Like the studies by Williams et al and Indelli et al, another study reported 1 patient treated with initial graft removal and successful revision ACL surgery 1 year after treatment.12 Zalavras et al also described a series of 5 infected ACL reconstructions treated with radical debridement and graft removal. Two patients had further procedures: 1 revision ACL reconstruction after 14 months and 1 TKA after 9 months.