Editorial Commentary: Postoperative Corticosteroid Injections After Knee Arthroscopy Appear to Increase the Risk for Infection the Closer They Are Administered to Surgery, but a Low Incidence and Unanswered Questions Around the Severity of Infection Continue to Pose Challenges for How to Best Counsel Patients.

Given the known immunosuppressive effects of glucocorticoids, the relationship between corticosteroid injections (CSIs) and postoperative infection risk has been frequently studied in the literature to date. The period within four weeks after knee arthroscopy has been identified as a particularly high-risk time to receive a CSI, and caution has been recommended as a result of the increased risk for infection that patients who receive a CSI during this time experience. CSIs given within four weeks prior to knee arthroscopy and at the time of knee arthroscopy have been shown to increase postoperative infection risk as well. As surgeons seek to better understand this association to be able to counsel patients about an appropriate interval between surgery and injection - as CSIs have been proven to accelerate postoperative recovery and reduce prolonged inflammation - questions remain, nonetheless. For example, while superficial infections may be localized and treated with a short course of oral antibiotics, deep infections can involve hospitalizations, intravenous antibiotics, and reoperation in the form of procedures like irrigation and debridement (I&D). Thus, the severity of infections associated with CSIs administered around the time of knee arthroscopy remains unclear. One explanation for these unanswered questions is the relative low frequency with which these complications occur and the fact that many studies that seek to address them rely on large commercial claims databases to do so. These databases frequently lack granularity, but due to the large sample size they offer, frequently provide the best available option to address such questions. Nevertheless, their limitations should be understood to avoid overstating clinical significance in the context of statistical significance and ensure conclusions are interpreted in their proper context.