The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Infection Following ACL Reconstruction: From Prevention to Treatment

Document Type : CURRENT CONCEPTS REVIEW

Authors
Mohammad Zarei Dezkooh 1
Sanaz Zabihi 1
Reza Binava 1
Reza Ganji 1
Amir Shahriar Ariamanesh 1
Hadi Makhmalbaf 1
Mohammad Hossein Ebrahimzadeh 1
Robert F. LaPrade 2
1 Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
2 Twin Cities Orthopedics, Edina, Minnesota, USA
10.22038/abjs.2026.96314.4319
Abstract
Postoperative infection is a rare, but serious, complication following anterior cruciate ligament reconstruction (ACLR). This review integrates current epidemiological trends, risk factors, and novel diagnostic and therapeutic approaches derived from the existing literature. The estimated incidence of septic arthritis (SA) after ACLR typically ranges from 0.14% to 2.6%. Male sex, smoking, hamstring autograft implantation, being diabetic, and increased body mass index (BMI) are significant risk factors.


Intraoperative vancomycin presoaking of the graft, known as the 'vancomycin wrap' technique, has significantly decreased infection rates and revolutionized prophylactic procedures. Clinical suspicion and laboratory markers, such as synovial fluid analysis and C-reactive protein (CRP), are used to make the diagnosis of infection.


Management often entails urgent arthroscopic debridement and individualized antibiotic treatment, with the principal aim of preserving the ACL graft. Although graft retention is successful in numerous cases, ongoing infection may require graft removal, which results in poorer outcomes.
Keywords
Anterior cruciate ligament reconstruction (ACLR)
Instability
Postoperative infection
Septic arthritis
Surgical site infection
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 8
August 2026
Pages 500-509

  • Receive Date 10 June 2026
  • Revise Date 27 June 2026
  • Accept Date 30 June 2026