Management Guidelines for Infection After ACL Reconstruction: Expert Opinion Statement Based on the Modified Delphi Survey of Indian Arthroscopy Surgeons

• Published in: Indian journal of orthopaedics Vol. 55; no. 2; pp. 342 - 351
• Main Authors: Geethan, I., Easwaran, Raju, Sahanand, Santhosh, Sivaraman, Arumugam, Gupta, Arun, Devgan, Ashish, Ashok, S., Bhasin, V. B., Joseph, Clement, Chaudhary, Deepak, Pardiwala, Dinshaw N., Gopinathan, P., John, John Thayyil, Maheshwari, J., Basumallick, Manabendra Nath, Antao, Nicholas, Shah, Nishith, Rajan, Palanivel, Sancheti, Parag, Dey, Paresh Chandra, Ayyadurai, Prakash, Gupta, Prateek Kr, Reddy, K. Raghuveer, Gupta, Ravi, Mittal, Ravi, Tapasvi, Sachin, Jos, Schiller Thekekara, Sinha, Skand, Sundararajan, S. R., Kumar, Vinod, Pandey, Vivek, Rajan, David V.
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.04.2021
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original; Original Article; Orthopedics; Surgical Orthopedics; Infection; Delphi survey; Anterior cruciate ligament reconstruction; Infection prevention; Management
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-021-00363-z

Aim Infection after anterior cruciate ligament (ACL) reconstruction, though rare, is a potentially devastating complication and the evidence-based recommendation on the various topics in its management is limited. The purpose of this study was to develop recommendations for the prevention and management of infections in ACL reconstruction surgery by performing a structured expert consensus survey using Delphi methodology. Materials and Methods 22 topics of relevance in the prevention and management of infection following ACL reconstruction were chosen from an extensive literature review. 30 panelists were requested to respond to a three-round survey, with feedback, to develop a consensus statement on the topics. Results Consensus statements could be prepared in eleven out of twenty-two topics including: the graft is retained at the first arthroscopic debridement, the graft is removed when repeated debridement are needed, and revision ACL reconstruction is needed only if the patient develops instability. Concurrence could be obtained in the topics including: longer duration of antibiotics is needed in immunocompromised patients, soaking graft in antibiotic solution reduces infection risk, and knee swelling without warmth does not suggest infection. Conclusions A proper skin preparation, a longer course of antibiotics in immunocompromised patients, and soaking the graft in antibiotics reduces the risk of infection. In case of infection, a healthy-looking graft must be retained at the first debridement and if the graft must be removed, revision ACL reconstruction is advised only if the patient develops instability.