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Objective: This meta-analysis aimed to evaluate the e!ectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction (ACL-R), with a focus on graft retention rates, functional outcomes, and the microbiological profile of infections.
Methods: This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562550). PubMed, Cochrane, ProQuest, and ScienceDirect databases were searched for studies published before July 2024 using predefined Medical Subject Headings terms and keywords related to ACL-R infections and arthroscopic irrigation and debridement. Inclusion criteria followed the PICO framework: Population (patients with septic arthritis following ACL-R), intervention (arthroscopic irrigation and debridement), comparator (none), and outcomes (graft retention rate, Lysholm Knee Score, International Knee Documentation Committee [IKD] score, and Tegner Activity Scale [TAS], and microbiology data). The risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies–of Interventions. Meta-analyses were performed using R Studio, with results presented as pooled proportions or means with 95% confidence intervals (95% CI).
Results: A total of 20 studies involving 333 patients were analyzed, with follow-up periods ranging from 18 days to 67 months. The pooled graft retention rate was 92% (95% CI [88–94%]), confirmed by proportional meta-analysis with low heterogeneity (I"=0%, P=2.0948). Functional knee outcomes showed pooled mean scores of 82.41 for Lysholm (95% CI [78.15–86.66], I"=87.3%–92.7%), 79.37 for IKDC (95% CI [74.00–84.75], I"=68.3%–82.2%), and 5.08 for TAS (95% CI [4.87–5.30], I"=0%–52.6%), indicating moderate to satisfactory recovery. Coagulase-negative Staphylococcus (42.34%) and Staphylococcus aureus (23.12%) were the most frequently isolated pathogens, with 9.91% of cases involving antibiotic-resistant strains, including MRSA (4.50%) and MR-CNS (5.41%). Cephalosporin or vancomycin was the most commonly administered first-line antibiotic, often combined with other agents.
Conclusion: The findings suggest that arthroscopic irrigation and debridement, combined with appropriate antibiotic therapy, are e!ective in managing septic arthritis following ACL-R, achieving a high graft retention rate of 92% and moderate to satisfactory functional outcomes. However, the presence of antibiotic-resistant pathogens and challenges in returning to high-level sports highlight the importance of preventive measures to protect athlete performance and recovery.
Level of Evidence: Level IV, Therapeutic Study.
Cite this article as: Mustamsir E, Pandu Aji A, Fernando A. Insights from the management of 333 ACL reconstruction infections: A systematic review and meta-analysis. Acta Orthop Traumatol Turc., 2025;59(1):7-17.