Strategies to minimize infection after anterior cruciate ligament reconstruction

Abstract

As septic arthritis after anterior cruciate ligament (ACL) reconstruction is an uncommon complication, information on prevention strategies has not been extensively studied before. This review will focus on collecting different published strategies for prevention of post-operative ACL infection. Regarding tobacco use, there is evidence that it increases the risk of infection; therefore, its use should be strongly discouraged. Preoperative intravenous antibiotics should be the standard of care of any patient undergoing an arthroscopic procedure in the knee. Intra-articular drains have no positive evidence for its use and therefore should be avoided. The literature suggests that patellar tendon autograft has the lowest risk of infection of any graft, recommending its use if the infection rate after ACL reconstruction wants to be minimized. Implementing a clinical pathway significantly improves the quality and consistency of care for patients undergoing ACL reconstruction and decreases the infection rates. Gentamicin irrigation solution may have a protective effect against septic arthritis development following arthroscopic ACL reconstruction, but more studies are needed to confirm its usefulness. Vancomycin presoaking of the grafts has shown to dramatically reduce the infection rate after ACL reconstruction and its use is strongly recommended especially when performing hamstrings autograft ACL reconstruction.