Deep knee
infection (DKI) after
anterior cruciate ligament reconstruction (ACLR) is rare and challenging. The optimal treatment strategy for
infection after ACLR remains controversial. This study aimed to investigate the optimal treatment for early
infection after ACLR surgery. Rats with unilateral ACLR were injected with 3.0 × 105 colony forming units (CFU) of Staphylococcus aureus in the knee joint for 7 days. Next, with surgical
debridement (SD) and/or 21 days of antimicrobial (systemic
vancomycin and oral
rifampicin [SVR])
therapy, rats were euthanatized and samples harvested. We evaluated signs of
infection by general postoperative conditions, serum inflammatory markers, microbiological counting, knee radiographs, micro-computed tomography (micro-CT), histologic staining, and scanning electron microscopy (SEM). Clinically, the data from 12 patients who suffered from DKI after ACLR were analyzed retrospectively. The DKI rats treated with SVR showed better outcomes in general postoperative conditions, serum inflammatory markers, microbiological counting, biofilm on the interference screw and graft, radiographic signs of periarticular osseous destruction, and inflammatory reaction in the joint tissues than those with SD treatment, while the DKI rats with SD and SVR administration showed the best outcomes. Rats which received SD and SVR administration had their S. aureus contamination completely eradicated. All patients treated with SD & SVR or SVR alone had effectively controlled knee
infections and achieved good knee function outcomes in the 6 months
after treatment, but one patient developed more serious knee
infections. Therefore, surgical
debridement combined with systemic
antibiotics treatment could effectively eliminate S. aureus contamination in the DKI rat model and in patients after ACLR without affecting knee function. Treatment with systemic
antibiotics could also control early DKI, which would be especially applicable in patients who could not tolerate surgery.