Meniscus repairs can be saved in the event of postoperative septic arthritis

  • Philipp Schuster
  • Markus Geßlein
  • Michael Schlumberger
  • Philipp Mayer
  • Hermann Josef Bail
  • Jörg Richter
Knee
  • 78 Downloads

Abstract

Purpose

No systematic studies on optimal treatment of postoperative septic arthritis following arthroscopic meniscus repair are available. The purpose of this study was to retrospectively evaluate the fate of repaired menisci in cases of postoperative septic arthritis, with treatment for infection focused on arthroscopic irrigation and debridement (I&D) and intention to maintain the meniscus.

Methods

Data of two sports orthopedics centers of the last 10 years were pooled (approximately 25,000 arthroscopic procedures of the knee). All cases of septic arthritis following arthroscopic meniscus repair were identified. These cases were retrospectively evaluated with regard to clinical course and management, especially the number of necessary I&Ds, if eradication was achieved, and if the repaired meniscus was retained or a partial resection was necessary (‘early failure’). Patients with initially maintained meniscus repairs were contacted if further meniscus surgery was performed in further follow-up (‘late failure’).

Results

20 patients with 23 repaired menisci were included. In 65% (13 cases), a concomitant anterior cruciate ligament reconstruction was performed. A mean of 2.0 ± 1.0 (1–4) arthroscopic I&Ds were performed in the treatment of septic arthritis. In two cases, additional open surgery was performed (after outside-in sutures). Eradication was achieved in all cases. Four repaired menisci (17.4%) showed loosened fixation or substantial degradation and were consequently partially resected within treatment for septic arthritis (early failures). The follow-up rate for the 19 initially maintained menisci was 94.7% after 3.0 ± 2.2 years (median 2.8, 0.4–7.8). Three of these underwent further partial resection (13.0%). Cumulative 3-year survival rate (Kaplan–Meier method) of all repairs was 70.7% (95% CI 50.3–91.1%), and for the subgroup of initially maintained menisci 85.6% (95% CI 67.0–100.0%), respectively.

Conclusion

Septic arthritis following meniscus repair can be successfully treated with (sequential) arthroscopic I&Ds. There is a considerable rate of early failures, however, in a mid-term follow-up the failure rate of initially retained menisci is low and comparable to what we know from the literature for cases without infection. Therefore, it is generally recommended to try to save the repaired menisci in these cases.

Level of evidence

IV, therapeutic case series.

Keywords

Infection Meniscus Repair Arthroscopy Complication Revision Resection Bacteria Suture Septic arthritis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethical committee of the institution.

Informed consent

Patients were informed, and they consented to conduct the study.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Philipp Schuster
    • 1
  • Markus Geßlein
    • 2
  • Michael Schlumberger
    • 1
  • Philipp Mayer
    • 1
  • Hermann Josef Bail
    • 2
  • Jörg Richter
    • 1
  1. 1.Centre for Arthroscopy and Sports MedicineOrthopedic Hospital MarkgroeningenMarkgroeningenGermany
  2. 2.Department of Orthopedics and Traumatology, Clinic NurembergParacelsus Medical Private UniversityNuernbergGermany

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