Corticosteroid injection up to 8 weeks prior to ACL reconstruction doubles the incidence of post-operative infection.

Abstract

Purpose: This study was performed to determine if at least one corticosteroid injection (CSI) within 8-weeks prior to Anterior Cruciate Ligament Reconstruction (ACL-R) increases the incidence of postoperative infection.

Methods: A large globally federated research database (TriNetX) containing over 200 million patient records was retrospectively queried for patients undergoing ACL-R between October 1st, 2010, and January 1st, 2024 using diagnosis and procedure codes. A cohort of patients receiving CSI up to 8-weeks prior to ACL-R were compared to a cohort of patients who did not receive a CSI prior to ACL-R. One-to-one Propensity score matching was performed based on preoperative characteristics and comorbid diagnoses. Outcomes examined were incidence of post-operative infection at 90 days and 180 days. Post-operative infection was defined as a formal infection diagnosis or need for a washout surgery. Comparisons were performed using Pearson Chi-squared tests.

Results: After matching, 2,439 patients were analyzed in each cohort with matched preoperative characteristics and comorbid diagnoses. Patients receiving a CSI in the 8 weeks prior to ACL-R had a 90-day infection rate of 1.2% (30/2,439) compared to a control group infection rate of 0.6% (14/2,439) represented as an odds ratio of 2.1 (95% CI 1.1-4.0, P=0.015). After 180 days the infection rates grew to 1.3% (33/2,439) for patients receiving CSI and 0.6% (15/2,439) for the control group with an odds ratio of 2.2 (95% CI 1.2-4.1, P=0.009).

Conclusions: Corticosteroid injections given within 8 weeks of ACL-Reconstruction approximately doubles the incidence of postoperative infection.

Level of evidence: III - Retrospective Cohort Study.