Septic arthritis (SA) following anterior cruciate ligament reconstruction (ACLR) is a rare (0.14% to 2.6%) but potentially devastating complication. Professional athletes have previously been reported to be at increased risk of septic arthritis after ACLR when compared to non-professionals, but the literature has been conflicting. The main reason for this lack of agreement has been due to the publication of studies that were underpowered and unable to detect a difference.
This FastFact reports the largest clinical study (4421 ACL reconstructions including 265 professional athletes) evaluating this topic to date1. The main finding was a confirmation of a significantly higher risk (odds ratio [OR], 21.0; 95% CI, 6.6-75.8; P < 0.0001) of septic arthritis after ACL reconstruction in professional athletes (incidence 3.8%) when compared with non-professional athletes (incidence 0.12%) in an adequately powered study. In order to address the limitations of previous studies but still utilize the published data, a pooled data analysis including all relevant previous articles and the current study was also performed. This gave an overall population of 11,416 ACLR, including over 1100 professional athletes. This pooled data analysis also demonstrated that professional athletes were at significantly greater risk of SA after ACLR (RR 4.9, 95% CI 1.18 to 20.65)
In the current series, univariate and multivariate analysis demonstrated that neither the type of graft, age, gender, BMI, whether a lateral tenodesis was performed or not, nor revision ACL reconstruction had any association with the risk of SA. Although non-significant, there was a trend towards more frequent deep infection in professional outdoor players participating in sports with skin contact.
A potential explanation for the elevated risk, is the observation that higher skin infection rates are reported in professional athletes involved in sports where there is frequent skin-to-skin contact. Furthermore, it has been demonstrated that contact sport athletes become more frequently colonised with Staphylococcus aureus than non-contact sports participants. To mitigate this risk, consideration should be given to measures aimed at reducing the risk of septic arthritis in professional athletes when performing an ACLR. This could include pre-soaking of the graft with topical vancomycin solution. This intervention has previously been reported to confer extremely low rates of septic arthritis following ACL reconstruction.
1Sonnery-Cottet B, Saithna A, Abreu FG, et al. Professional athletes are at higher risk of septic arthritis after Anterior Cruciate Ligament reconstruction: An analysis of 4421 consecutive patients including 265 Elite Athletes from the SANTI Study Group. Am J Sports Med. 2019 Aug 28:363546519869326. doi: 10.1177/0363546519869326.