Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 10; pp. 4090 - 4098
• Main Authors: Schmitz, Jesper Kraus, Omar, Osama, Nordkvist, Adam, Hedevik, Henrik, Janarv, Per-Mats, Stålman, Anders
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2023; Springer Nature B.V
• Subjects: ACL; Anterior cruciate ligament; Arthritis; Autografts; Clinical outcomes; Cohort analysis; Knee; Ligaments; Medical records; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Orthopedics; Osteoarthritis; Patients; PROMs; Quality of life; Revision; Revisions; Risk; Sports Medicine; Surgery; ACL; Revision; Osteoarthritis; PROMs
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1007/s00167-023-07498-6

Purpose The primary aim of this study is to analyse the patient-reported outcomes after ACLR complicated by septic arthritis. The secondary aim is to examine the 5-year risk of revision surgery after primary ACLR complicated by septic arthritis. The hypothesis was that patients with septic arthritis after ACLR are more likely to have lower PROMs scores and an increased risk of revision, compared with patients without septic arthritis. Materials and methods All primary ACLRs, with a hamstring or patellar tendon autograft ( n  = 23,075), in the Swedish Knee Ligament Register (SKLR) between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare to identify patients with postoperative septic arthritis. These patients were verified in a nationwide medical records analysis and compared with patients without infection in the SKLR. The patient-reported outcome was measured using the Knee injury and Osteoarthritis Index Score (KOOS) and the European Quality of Life Five Dimensions Index (EQ-5D) at 1, 2 and 5 years postoperatively and the 5-year risk of revision surgery was calculated. Results There were 268 events of septic arthritis (1.2%). The mean scores on the KOOS and EQ-5D index were significantly lower for patients with septic arthritis on all subscales on all follow-up occasions compared with patients without septic arthritis. Patients with septic arthritis had a revision rate of 8.2% compared with 4.2% in patients without septic arthritis (adjusted hazard ratio 2.04; confidence interval 1.34–3.12). Conclusion Patients suffering from septic arthritis following ACLR are associated with poorer patient-reported outcomes at 1-, 2- and 5-year follow-ups compared with patients without septic arthritis. The risk of revision ACL reconstruction within 5 years of the primary operation for patients with septic arthritis following ACLR is almost twice as high, compared with patients without septic arthritis. Level of evidence III.