关节镜清理结合灌注冲洗治疗前交叉韧带重建术后关节感染

目的:探讨膝关节前交叉韧带重建术后关节感染的治疗策略。方法:2005年3月至2014年2月关节镜下前交叉韧带重建术后关节感染6例,均为男性,年龄18～36岁。患者术后出现膝关节疼痛肿胀,血沉和C-反应蛋白升高,细菌培养均为表皮样葡萄球菌。采用关节镜清理和置管灌注冲洗。按照Lysholm膝关节评分系统和膝关节活动度对患者进行评价。结果:所有患者的感染均被控制,血沉和C反应蛋白恢复正常,Lysholm膝关节评分85～95分,膝关节活动度120°～135°。结论:前交叉韧带重建术后关节感染,早期采用关节镜清理和置管灌注冲洗获得满意疗效。     

关节镜下前交叉韧带重建术后膝关节感染的预防与治疗

目的探讨膝关节镜下前交叉韧带(ACL)重建术后膝关节化脓性感染的预防与治疗方法。方法回顾性分析自2007-01—2014-01关节镜下ACL重建术后膝关节化脓性感染6例。对于高度怀疑ACL重建术后膝关节化脓性感染的患者立即行关节腔穿刺抽液,每次送一式2份标本,然后尽早大剂量静脉使用广谱抗生素(四代头孢类抗生素),并积极做好术前准备,在硬膜外麻醉下行关节镜下探查清理和冲洗术,术后抗生素溶液(主要是庆大霉素溶液)关节腔持续灌洗。结果本研究286例中有6例发生了膝关节化脓性感染,感染发生率为2.1%。感染患者接受关节镜下探查清理和冲洗术后第2~4天症状明显缓解,经过正规治疗后没有复发病例。术后关节活动度恢复至与健侧一致,前抽屉试验和Lachman试验均为阴性。KT-2000检查与健侧比较:30°位(1.7±0.6)mm,90°位(1.0±0.9)mm。6例随访时间12~24个月,平均16个月,膝关节活动度及韧带功能良好。结论关节镜下ACL重建术后膝关节化脓性感染可能会导致严重后果,采取严格的预防措施可以有效降低感染发生率。对于疑似或者确诊感染患者,尽早行关节镜下清理手术和抗生素溶液关节腔持续灌洗,术后结合抗生素治疗,辅以积极有效的功能训练,可以取得良好的临床效果。     

关节镜下前交叉韧带重建术后早期感染三例北大核心CSCD

目的报道3例关节镜下前交叉韧带重建术后早期感染患者临床资料,总结治疗方法及疗效,分析预防措施。方法 2015年3月—2017年3月,关节镜下前交叉韧带重建术后3例发生早期感染。其中男2例,女1例;年龄30、39、32岁。术后7 d出现膝关节疼痛伴低热症状,均存在关节腔积液,其中1例积液细菌培养呈阳性;白细胞计数及中性粒细胞计数在正常范围,超敏C-反应蛋白及红细胞沉降率升高。2例给予万古霉素、1例给予关节镜下关节腔清理术后治愈。结果 3例患者经抗感染治疗后,临床症状及体征均消失,感染治愈;白细胞计数及中性粒细胞计数、超敏C-反应蛋白、红细胞沉降率均在正常范围。术后90 d膝关节Lysholm评分为89、88、80分。结论关节镜下前交叉韧带重建术后早期感染的发生可能与手术时间延长及关节腔积液有关,经长期口服利福平抗感染治疗后可获较好临床疗效。     

急诊关节镜下清创复位联合二期韧带重建治疗急性膝关节后外侧旋转脱位

目的总结急诊关节镜下复位清创联合二期韧带重建手术在急性膝关节后外侧旋转脱位治疗中的效果。方法回顾性分析2007年9月至2008年8月第三军医大学西南医院收治的3例急性膝关节后外侧旋转脱位患者的临床资料,3例患者均急诊行关节镜手术清创＋复位治疗,其中1例内侧副韧带（MCL）Ⅲ度损伤患者行MCL修补缝合术;2例MCLⅡ度损伤患者佩戴铰链支具保守治疗。术后3个月,3例患者接受LARS人工韧带前交叉韧带（ACL）重建术。观察患者膝关节活动度和Lysholm评分结果。结果平均随访15个月。3例患者均未出现膝关节前向不稳,前抽屉试验、轴移试验阴性;均未发生关节内异位骨化等病变。术后3个月,3例患者的膝关节活动度分别为0°～130°、0°～120°、0°～130°;重建术后12个月,3例患者的Lysholm评分分别为91、88、94分。结论急诊关节镜下复位、关节腔清理术结合标准化的ACL重建术对于膝关节后外侧旋转脱位的治疗效果较好。     

前交叉韧带囊肿的临床表现与关节镜治疗

目的：探讨膝关节前交叉韧带囊肿的临床表现和关节镜手术疗效.方法：回顾性分析自2005年1月至2010年12月收治的12例症状性膝关节前交叉韧带囊肿的资料.男8例,女4例;年龄19～53岁,平均（33.7±9.5）岁;左膝5例,右膝7例;病程3～48个月,平均（15.8±13.2）个月.术中关节镜下完整切除前交叉韧带囊肿.记录术前术后膝关节的活动度,膝关节功能采用Lysholm评分标准进行评定.结果：术后患者切口均Ⅰ期愈合,无相关并发症发生.12例均获随访,时间24～48个月,平均（32.3±6.6）个月.患膝关节疼痛、肿胀、交锁症状均消失,随访期间无复发.术后关节活动度及Lysholm评分均较术前明显改善.结论：关节镜诊治症状性前交叉韧带囊肿具有创伤小、恢复快的优点,是治疗症状性膝关节前交叉韧带囊肿的有效治疗手段.     

关节镜下治疗前交叉韧带摩擦撞击症

回顾性分析关节镜下治疗膝关节股骨髁、胫骨嵴摩擦撞击前交叉韧带的疗效。方法对126例膝关节退行性骨关节炎关节镜下治疗,28例前交叉韧带磨损撞击者,镜下观察行膝关节清理、髁间窝扩大成形术、胫骨骨嵴摘除术。结果本组28例均获随访,随访时间12～16个月,平均18个月.术后关节功能明显改善。结论膝关节骨性关节炎部分股骨髁、胫骨嵴增生磨损前交叉韧带,关节镜手术应注意观察前交叉韧带磨损情况.手术处理后可获得良好效果。     

保留韧带残端对关节镜下前交叉韧带重建手术疗效的影响

目的 观察保留韧带残端对关节镜下前交叉韧带重建手术疗效的影响。方法 回顾性分析自2020-01—2022-12采用关节镜手术治疗的33例前交叉韧带损伤,其中15例保留韧带残端重建前交叉韧带（观察组）,18例未保留韧带残端重建前交叉韧带（对照组）。比较两组手术时间、住院时间、术后6个月膝关节Lysholm评分、术后6个月膝关节IKDC评分。结果 33例均获得随访,随访时间为6～28个月,平均16个月。随访期间所有患者均未出现术后感染、膝关节不稳、Cyclops病变。观察组与对照组手术时间、住院时间、术后6个月膝关节IKDC评分差异无统计学意义（P>0.05）。观察组术后6个月膝关节Lysholm评分较对照组高,差异有统计学意义（P<0.05）。结论 关节镜下前交叉韧带重建术中无论是否保留韧带残端均能获得满意的临床疗效,而保留韧带残端的前交叉韧带重建术后患者膝关节功能Lysholm评分相对更高。然而本研究着眼于功能性评价,缺乏对患者本体感觉、生物学改变、组织病理学研究,上述结论还需要纳入更多样本量的临床研究证实。     

关节镜下微创治疗膝交叉韧带损伤合并下肢深静脉血栓

目的探讨关节镜下治疗膝关节交叉韧带损伤合并下肢深静脉血栓形成的方法及近期临床疗效。方法对25例膝交叉韧带损伤合并单侧下肢静脉血栓的患者行关节镜下交叉韧带重建术。结果所有患者术后均未出现肺栓塞、感染等并发症,手术前后Lysholm与IKDC(%)评分比较差异有统计学意义(P<0.05)。结论膝关节交叉韧带损伤合并下肢深静脉血栓并非手术绝对禁忌证,术前明确诊断、早期治疗可获得较满意的疗效。     

膝关节交叉韧带囊肿的关节镜治疗

目的 探讨关节镜手术治疗膝关节交叉韧带囊肿的疗效.方法 2010年9月~2012年9月关节镜下治疗膝关节交叉韧带囊肿14例,采用常规前内、前外入路,或合并后外侧入路关节镜下切除交叉韧带囊肿,切取的囊壁组织送病检.结果 14例随访4~28个月,平均12.6月,术前关节活动度4°~105°,术后增加至0°~130°.术后膝关节Lysholm评分（92.1±6.9）分,较术前（61.9±20.1）分明显提高（t=5.981,P=0.000）.结论 关节镜下治疗膝关节交叉韧带囊肿效果确切.     

关节镜下前交叉韧带重建术后早期感染三例

目的报道3例关节镜下前交叉韧带重建术后早期感染患者临床资料,总结治疗方法及疗效,分析预防措施。方法 2015年3月—2017年3月,关节镜下前交叉韧带重建术后3例发生早期感染。其中男2例,女1例;年龄30、39、32岁。术后7 d出现膝关节疼痛伴低热症状,均存在关节腔积液,其中1例积液细菌培养呈阳性;白细胞计数及中性粒细胞计数在正常范围,超敏C-反应蛋白及红细胞沉降率升高。2例给予万古霉素、1例给予关节镜下关节腔清理术后治愈。结果 3例患者经抗感染治疗后,临床症状及体征均消失,感染治愈;白细胞计数及中性粒细胞计数、超敏C-反应蛋白、红细胞沉降率均在正常范围。术后90 d膝关节Lysholm评分为89、88、80分。结论关节镜下前交叉韧带重建术后早期感染的发生可能与手术时间延长及关节腔积液有关,经长期口服利福平抗感染治疗后可获较好临床疗效。     

Methicillin-Resistant Staphylococcus aureus–Induced Septic Arthritis After Anterior Cruciate Ligament Reconstruction

We encountered a case of methicillin-resistant Staphylococcus aureus (MRSA)–induced septic arthritis after anterior cruciate ligament (ACL) reconstruction. A 20-year-old woman underwent left double-bundle ACL reconstruction by use of the hamstring tendon 18 months after her injury. She had a fever higher than 39°C, and swelling of the left knee developed on day 5 after surgery. The white blood cell count was 19,500/μL, and the C-reactive protein level was 16.9 mg/dL. Arthroscopic debridement with joint lavage was performed on day 7, followed by intermittent articular irrigation. Because the arthritis was not remitted, arthroscopic debridement with joint lavage was repeated, and the reconstructed ligament and hardware were removed on day 10. Intermittent articular irrigation was continued, but the arthritis still was not remitted, so a third arthroscopic debridement with joint lavage was performed on day 22. After treatment, continuous articular irrigation had been performed for 14 days until culture negativity of synovial fluid was confirmed. After methicillin-resistant Staphylococcus aureus was identified, vancomycin hydrochloride (2 g) was systemically administered for 29 days until the test for C-reactive protein became negative. Joint mobilization and revision ACL reconstruction by use of bone-tendon-bone were performed 2 months and 1 year, respectively, after the primary surgery.     

Septic arthritis in postoperative anterior cruciate ligament reconstruction

A review of postoperative infected anterior cruciate ligament reconstructions was done on 3500 consecutive arthroscopic procedures. The purpose was to assess incidence, diagnosis, treatment, and outcome factors. Six postoperative intraarticular infections were detected. Average followup was 3 years (range, 2-8 years). The rate of infection was 0.14%. Five men and one woman with a median age of 32.5 years (range, 20-51 years) comprised the study group. The average interval from the onset of symptoms to the initial arthroscopic intervention was 7.5 days (range, 2-20 days). Staphylococcus aureus was present in three knees, Staphylococcus epidermidis in two, and Streptococcus nonhemolytic in one. All patients had initial arthroscopic debridement and lavage followed by 6 weeks of intravenous antibiotics. Two grafts were removed: one patient had delayed ligament reconstruction and the other had total knee arthroplasty. The remaining patients had full range of motion. In the group with the best result, two patients had Staphylococcus epidermidis and one had Staphylococcus aureus, which was treated 2 days after clinical symptoms began. The other two patients infected with Staphylococcus aureus had unsatisfactory results. Anterior cruciate ligament infection is rare, but diagnosable. When treated early with appropriate antibiotic therapy and arthroscopic debridement, four of six grafts were retained. If the infection does not respond rapidly to early therapy, then graft removal is an option.     

关节镜下前交叉韧带重建术后感染的诊断与治疗要点

目的探讨前交叉韧带（ACL）重建术后关节内感染的诊断标准、预防及治疗关键点。方法回顾性分析2007-01—2012-12关节镜下行ACL重建术后关节内感染5例患者的临床资料。术后关节内感染的诊断标准：膝疼痛在术后再度加重,伴体温升高;膝肿胀、积液或切口红肿;血液白细胞、中性粒细胞比例、ESR、CRP升高;关节液白细胞、中性粒细胞比例升高,葡萄糖浓度降低,以及细菌培养。总结5例感染者诊断、治疗过程及结果并回顾相关文献。结果关节镜下ACL重建术102例中5例术后发生关节内感染（4.9%）,其中仅1例细菌培养阳性（0.98%）。采取清创后持续冲洗引流或间断穿刺冲洗治疗后保留移植韧带4例。结论 ACL重建术后关节内感染的治疗原则：早期干预以提高韧带保留率;清创后持续冲洗引流;使用敏感抗生素足疗程治疗;石膏或支具制动,延迟功能锻炼。     

Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case–control study

Purpose

This study was undertaken to prospectively analyse, at a mean five-year follow-up, the clinical, functional, and radiographic outcomes in patients who developed postoperative acute septic knee arthritis following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We also assessed the effect of multiple arthroscopic debridement and graft retention on the functional outcomes in comparison with the matched control group.

Methods

From a consecutive case series of 2,560 ACL-injured patients who were treated with arthroscopic ACL reconstruction, we report on 24 cases with postoperative septic knee arthritis. These patients were individually matched for age, sex, comorbidity, body mass index (BMI) and preinjury Tegner activity scale in a ratio of 1/1. Clinical, laboratory, synovial fluid analysis and culture were performed. Arthroscopic debridement and graft retention was done for all cases, in addition to antibiotic therapy IV. A detailed physical examination, KT1000 laxity testing, Lysholm knee score, Tegner activity level scale, International Knee Documentation Committee (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were completed.

Results

In all cases, treatment of infection was successful after a median of three (range one to six) repeated arthroscopic graft debridement and retention, in addition to antibiotic therapy IV. At an average of five years follow-up, two patients had over five millimetres manual maximum side-to-side difference in laxity. There were no significant differences between groups regarding Lysholm score, IKDC and KOOS. Median final Tegner activity score was 5.5 versus 7 in the control group (p = 0.004). Complications included graft rupture in three patients, loss of range of motion in five, Sudeck’s atrophy in one and moderate joint narrowing in two. There were no recurrences of septic arthritis or bone infection.

Conclusion

Graft retention seems not only possible but appropriate in view of the experience presented in this article for postoperative septic knee arthritis using hamstring autograft. A potential residual complication is arthrofibrosis, which deserves maximum attention.     

The role of arthroscopy in children and adolescents

A retrospective review of the first 5 years' experience with arthroscopy at the Adelaide Children's Hospital was conducted. Two hundred and twelve arthroscopies were performed in 192 patients. The average period of follow-up was 5.9 months. The most common arthroscopic finding was anterior cruciate ligament (ACL) injury, followed by meniscal lesions, chondromalacia patellae, patellar dislocations, and osteochondritis dissecans. There was a high rate of associated lesions with ACL tears and acute patellar dislocation. Septic arthritis responded well to arthroscopic drainage and lavage. We concluded that arthroscopy is a safe and accurate diagnostic and therapeutic tool in childhood and adolescence. Arthroscopy is recommended when a joint is too painful to allow adequate clinical examination, in hemarthroses, for ACL injury, after acute patellar dislocation, and to treat septic arthritis. There is only a 56% chance of making a correct diagnosis on clinical grounds, which contrasts with an accuracy in excess of 99% with arthroscopy.     

Presentation,outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study

Purpose:The objective of this study was to examine clinical presentation and medium-term outcome of patients with septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction.Type of Study:Matched case control study.Methods:From a consecutive case series of 575 patients who underwent ACL reconstruction from 1996 through 1999, we report on 10 patients (1.7%) with postoperative septic arthritis. These patients were compared with individually matched patients without infection, on average, 3 years after surgery. The examination included physical and radiographic evaluation, functional testing, KT-1000, Lysholm and Tegner scales, and the International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS) form.Results:The predominant clinical presentation among patients with septic arthritis was modest classic signs of local infection. However, all had fever and elevated sedimentation rate or high C-reactive protein. Bacterial cultures showed coagulase-negative Staphylococcus species in 6, Staphylococcus aureus in 1, and Propionibacteriaceae species in 1 patient. The diagnosis was established with a delay of approximately 5 days. All patients underwent arthroscopic debridement and lavage (2 cases) or continuous irrigation (8 cases), as well as antibiotic treatment. One experienced graft rupture caused by the infection. At the end of the follow-up evaluation, the infected patients reported significantly lower activity levels than the control subjects (mean Tegner score, 5.3 v 7.2, P = .03). No statistically significant differences were noted in mean Lysholm, IKDC, or KOOS scores, or in KT-1000 difference. Two infected patients scored lower on the Tegner and Lysholm scales postoperatively than they did preoperatively. When examining the causes of infection, we found contamination by coagulase-negative Staphylococcus on supposedly sterile suture clamps on 3 graft preparation boards.Conclusions:In cases of suspected septic arthritis after ACL reconstruction, laboratory studies and aspiration followed by culture testing should be performed liberally to avoid the otherwise frequently delayed diagnosis. The inferior postoperative activity level noted in infected patients appeared not to be secondary to graft failure but may be related to arthrofibrosis, cartilage damage, or recurring postinfectious meniscal tears.     

Acute extension block caused by anterior cruciate ligament tear: A case report

Acute knee locking is usually attributed to a displaced meniscus tear. This case involved late diagnosis of mechanical extension block caused by anterior displacement of a torn anterior cruciate ligament (ACL) with impingement in extension. Definitive reconstruction was delayed after debridement of the ACL stump to improve preoperative range of motion. Despite this, the patient still had difficulty regaining extension after surgery. Early treatment of mechanical extension block may facilitate motion recovery after ACL reconstruction.     

Meniscal tears sustained awaiting anterior cruciate ligament reconstruction

We reviewed 68 patients who underwent anterior cruciate ligament (ACL) reconstruction after initial EUA & arthroscopy in the knee unit of a United Kingdom district general hospital. Mean time between injury and ACL reconstruction surgery was 23.3 months with the incidence of meniscal tear at reconstruction being 67.6%. In this series 10.3% of patients sustained a meniscal tear in the delay period between arthroscopy and reconstruction surgery. Meniscal tear is strongly associated with ACL rupture and also a poorer outcome following reconstruction surgery. The delay in diagnosis and wait for reconstruction surgery that patients experience are potentially worsening surgical outcomes in the anterior cruciate deficient knee.