一项系统综述：前交叉韧带重建术后移植物移除感染的患者比移植物保留治疗的患者预后更差

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-03-06 DOI:10.1002/jeo2.70147

Daniel C. Lewis, Natalya E. McNamara, Erin M. Tabish, Joseph T. Featherall, Hillary W. Rawson, Gregoire Micicoi, Daniel J. Song, Justin J. Ernat

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引用次数: 0

摘要

目的本研究的目的是评估前交叉韧带重建（ACLR）并发脓毒性关节炎患者采用移植物保留与移植物去除治疗方案的结果。其次，本研究旨在评估移植物保留与移植物去除的外科、人口统计学和微生物手术指征。我们假设，接受移植物切除的患者预后更差，而由耐甲氧西林金黄色葡萄球菌或铜绿假单胞菌等毒性更强的生物引起的脓毒性关节炎患者更有可能接受移植物切除。方法对PubMed和Ovid数据库中关于ACLR术后移植物保留与移植物去除治疗脓毒性关节炎的文献进行系统回顾和荟萃分析。纳入的研究以英文发表在同行评审的期刊上，平均最低随访时间为1年，并报道了关节镜下ACLR、感染的手术处理、治疗期间移植物保留与移植物去除以及结果测量。分析患者人口统计学、手术和预后数据。结果纳入24篇文献，共307例患者。接受同种异体ACLR移植的患者（p = 0.02）和由铜绿假单胞菌引起的脓毒性关节炎患者（p = 0.03）更容易接受移植物切除。移植物切除患者的冲洗和清创次数较多（2.7±0.8比2±1.5,p < 0.01）。接受移植物去除治疗的患者在KT-1000测量中松弛度增加（3.30±134比1.55±1.23,p < 0.01）， 2000年国际膝关节文献委员会主观膝关节评估评分较低（66.57±17.08比80.18±15.21,p = 0.02）。结论ACLR后脓毒性关节炎是一种毁灭性的并发症。移植物保留和移植物去除方案都有报道，并且是可行的选择。接受移植物移除治疗的患者预后指标较差。铜绿假单胞菌和同种异体ACLR引起的脓毒性关节炎更可能采用移植物切除治疗。ACLR后脓毒性关节炎仍然是一个不常见但困难的问题。很少有文献指导移植物保留与移植物去除的治疗方案。证据水平低水平研究的IV级系统评价。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Patients treated for infection following ACL reconstruction with graft removal have poorer outcomes than those treated with graft retention: A systematic review

Purpose

The purpose of this study was to evaluate patient outcomes following anterior cruciate ligament reconstruction (ACLR) complicated by septic arthritis treated with graft retention versus graft removal protocols. Secondarily, this study aimed to evaluate surgical, demographic and microbial surgical indications for graft retention versus graft removal. We hypothesised that patients who underwent graft removal would have worse outcomes and that patients with septic arthritis caused by more virulent organisms, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, would be more likely to undergo graft removal.

Methods

A systematic review and meta-analysis of literature in the PubMed and Ovid databases regarding the treatment of septic arthritis following ACLR reporting graft retention versus graft removal was conducted. The included studies were published in English, in peer-reviewed journals, with an average minimum follow-up of 1 year, and reported on arthroscopic ACLR, surgical management of infection, graft retention versus graft removal during treatment and outcome measures. Patient demographic, surgical and outcome data were analysed.

Results

Twenty-four studies reporting on 307 patients were included for analysis. Patients who underwent allograft ACLR (p = 0.02) and patients with septic arthritis caused by P. aeruginosa (p = 0.03) were more likely to undergo graft removal. Patients treated with graft removal were treated with more irrigation and debridement procedures (2.7 ± 0.8 vs. 2. ± 1.5, p < 0.01). Patients treated with graft removal had increased laxity on KT-1000 measurement (3.30 ± 134 vs. 1.55 ± 1.23, p < 0.01), and lower 2000 International Knee Documentation Committee Subjective Knee Evaluation scores (66.57 ± 17.08 vs. 80.18 ± 15.21, p = 0.02).

Conclusions

Septic arthritis following ACLR is a devastating complication. Both graft retention and graft removal protocols have been reported and are viable options. Patients treated with graft removal had poorer outcome measures. Septic arthritis caused by P. aeruginosa and allograft ACLR were more likely to be treated with graft removal.

Clinical Relevance

Septic arthritis following ACLR remains an uncommon, but difficult problem. There is minimal literature guiding graft retention versus graft removal treatment protocols.