Prevalence of Septic Arthritis After Anterior Cruciate Ligament Reconstruction Among Professional Athletes

1. Bertrand Sonnery-Cottet, MD*,†, 
2. Pooler Archbold, MD†, 
3. Rachad Zayni, MD†, 
4. Juliano Bortolletto, MD†, 
5. Mathieu Thaunat, MD†, 
6. Thierry Prost, MD‡, 
7. Vitor B.C. Padua, MD§ and 
8. Pierre Chambat, MD†

+Author Affiliations

1. ^†Centre Orthopédique Santy, Lyon, France
2. ^‡Agence Régionale de Santé Rhône-Alpes, Annecy, France
3. ^§Clinica Hilario Maldonado, Marilia, Brazil
4. Investigation performed at The Centre Orthopédique Santy, Lyon, France

1. ↵* Bertrand Sonnery-Cottet, MD, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France (e-mail: sonnerycottet@aol.com).

Abstract

Background: Septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction is a rare complication. Its prevalence and characteristics have never been reported among professional athletes.

Purpose: To report the prevalence and the characteristics of septic arthritis after ACL reconstruction in professional athletes and a general population of patients.

Study Design: Case control study; Level of evidence, 3.

Methods: A retrospective analysis of a consecutive series of 1957 patients who underwent an ACL reconstruction between 2003 and 2008 was performed; 88 patients were professional athletes. The patient demographics, the prevalence of infection, the involved organism, and the method of treatment were reviewed. Three potential risk factors for infection—level of sporting participation, indoor/outdoor sports, and the presence or not of a combined lateral tenodesis—were assessed using univariate and multivariate logistic regression analysis.

Results: The prevalence of septic arthritis was 0.37% in the nonprofessional group and 5.7% in the professional athlete population. Being a professional athlete (odds ratio [OR], 16.0; 95% confidence interval [CI], 3.9-59.8; P = .0001) or having a combined lateral tenodesis (OR, 4.8; 95% CI, 1.04-18.04; P = .02) was found to be significantly correlated with septic arthritis after ACL reconstruction. A significant correlation exists between being a professional athlete and having a combined lateral tenodesis (χ² = 16.7; P = 4 × 10⁻⁵), suggesting a potential confounding role is played by one of these variables. All the cases of infection in the professional athletes occurred in those who participated in outdoor sports, although this was not found to be statistically significant (P = .17).

Conclusion: Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction.

Keywords:

• septic arthritis
 
• anterior cruciate ligament
 
• professional athletes