Inflammatory blood marker patterns following uncomplicated arthroscopically-assisted anterior cruciate ligament reconstruction
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Published:
Jun 11, 2015
Keywords:
Anterior cruciate ligament, C-reactive protein, Septic arthritis
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Abstract
ObjectiveThe purpose of this report was to determine the levels of inflammatory blood markers over the time after a successful arthroscopic anterior ligament reconstruction and to analyze if any variables of surgical treatment alter this blood marker.MethodsA prospective review was conducted including all anterior cruciate ligament reconstruction performed in our institution between December 2012 and December 2013. C-reactive protein, erythrocyte sedimentation rate and white blood cell count were determined before surgery and days 1, 15 and 30 postoperatively. Different variables of surgical treatment were collected: ischemic and surgical time, type of graft, associated injuries or type of treatment (meniscal suture, microfractures, etc.).ResultsC-reactive protein rose abruptly with surgery and decreased progressively over the time. This was the only markers that returned to preoperative levels by day 30 (P >0.05). Ischemic time was associated with high levels of C-reactive protein. None of the associated treatments had significant effect on C-reactive protein, erythrocyte sedimentation rate or white blood cell count.ConclusionsBlood levels of C-reactive protein can help to take a therapeutic decision when an infection is suspected. If elevated C-reactive protein levels persist after 15 days after surgery, the presence of infection through arthrocentesis must be ruled out.
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Hernán Prado, M. A., Neves Teixeira, A. S., Martin Flores, E., & Llopis Miró, R. (2015). Inflammatory blood marker patterns following uncomplicated arthroscopically-assisted anterior cruciate ligament reconstruction. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 80(2), 70-75. https://doi.org/10.15417/430
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Clinical Research
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References
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of acute knee effusion after anterior cruciate ligament reconstruction: what is found in patients with a noninfected, painful
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a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 2009;25(3):243-9.
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cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 1997;25(2):261-7.
6. Calvisi V, Lupparelli S. C-reactive protein changes in the uncomplicated course of arthroscopic anterior cruciate ligament
reconstruction. Int J Immunopathol Pharmacol 2008;21(3):603-7.
7. Binnet MS, Başarir K. Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction
techniques. Arthroscopy 2007;23(8):862-8.
8. Fong SY, Tan JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore
2004;33(2):228-34.
9. Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following arthroscopic anterior cruciate ligament reconstruction.
Arthroscopy 2006;22(4):375-84.
10. Schollin-Borg M, Michaëlsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament
reconstruction: a case control study. Arthroscopy 2003;19(9):941-7.
11. Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H. Septic arthritis after arthroscopic anterior cruciate ligament
reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 2007;35(7):1059-63.
12. Wang C, Ao Y, Fan X, Wang J, Cui G, Hu Y, Yu J. C-reactive protein and erythrocyte sedimentation rate changes after
arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection. Arthroscopy
2014;30(9):1110-5.
13. Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res
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14. Lindström T, Gullichsen E, Heinonen O, Grönroos J, Nevalainen T, Niinikoski J. Group II phospholipase A2 in serum after
knee surgery and intramedullary nailing of tibial shaft fracture. Injury 1997;28(3):169-71.
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Med Chil 2005;133(11):1341-8.
16. Corbatón Anchuelo A, Llamas Cascón E, García Méndez P, Sánchez Llorente T, López Hernández G, De la Gala Sánchez
F. Evolución de los reactantes de fase aguda y del metabolismo del hierro en artroscopia de rodilla por meniscopatía y en plastias
de ligamento cruzado anterior. Patología del Aparato Locomotor 2006;4(2):87-97.
17. Margheritini F, Camillieri G, Mancini L, Mariani PP. C-reactive protein and erythrocyte sedimentation rate changes following
arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2001;9(6):343-5.
18. Ruiz-Ibán AM, Diaz Heredia J, Cebreiro Martinez I, Alonso Güemes S, Cuellar Gutierrez R. Evolution of C-reactive
protein values in the first month alter anterior cruciate ligament reconstruction: reference values. Knee Surg Sports Traumatol
Arthrosc 2013;(11) [publicación en línea]
19. Gavriilidis I, Pakos EE, Wipfler B, Benetos IS, Paessler HH. Intra-operative hamstring tendon graft contamination in anterior
cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17(9):1043-7.
20. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J. Outcomes of postoperative septic arthritis after anterior cruciate
ligament reconstruction. Am J Sports Med 1999;27(5):562-70.
2011;39(1):199-217.
2. Paci JM, Schweizer SK, Wilbur DM, Sutton LG, Werner FW, Scuderi MG, Cannizzaro JP. Results of laboratory evaluation
of acute knee effusion after anterior cruciate ligament reconstruction: what is found in patients with a noninfected, painful
postoperative knee? Am J Sports Med 2010;38(11):2267-72.
3. Sechriest VF 2nd, Carney JR, Kuskowski MA, Haffner JL, Mullen MJ, Covey CD. Incidence of knee sepsis after ACL
reconstruction at one institution: the impact of a clinical pathway. J Bone Joint Surg Am 2013;95(9):843-9.
4. Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction:
a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 2009;25(3):243-9.
5. Williams RJ 3rd, Laurencin CT, Warren RF, Speciale AC, Brause BD, O’Brien S. Septic arthritis after arthroscopic anterior
cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 1997;25(2):261-7.
6. Calvisi V, Lupparelli S. C-reactive protein changes in the uncomplicated course of arthroscopic anterior cruciate ligament
reconstruction. Int J Immunopathol Pharmacol 2008;21(3):603-7.
7. Binnet MS, Başarir K. Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction
techniques. Arthroscopy 2007;23(8):862-8.
8. Fong SY, Tan JL. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore
2004;33(2):228-34.
9. Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following arthroscopic anterior cruciate ligament reconstruction.
Arthroscopy 2006;22(4):375-84.
10. Schollin-Borg M, Michaëlsson K, Rahme H. Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament
reconstruction: a case control study. Arthroscopy 2003;19(9):941-7.
11. Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H. Septic arthritis after arthroscopic anterior cruciate ligament
reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 2007;35(7):1059-63.
12. Wang C, Ao Y, Fan X, Wang J, Cui G, Hu Y, Yu J. C-reactive protein and erythrocyte sedimentation rate changes after
arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection. Arthroscopy
2014;30(9):1110-5.
13. Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res
1992;(275):237-42.
14. Lindström T, Gullichsen E, Heinonen O, Grönroos J, Nevalainen T, Niinikoski J. Group II phospholipase A2 in serum after
knee surgery and intramedullary nailing of tibial shaft fracture. Injury 1997;28(3):169-71.
15. Orrego LM, Pérez CM, Pérez YM, Cheyre EJ, Mardones PR. [Plasma C reactive protein in elective orthopedic surgery]. Rev
Med Chil 2005;133(11):1341-8.
16. Corbatón Anchuelo A, Llamas Cascón E, García Méndez P, Sánchez Llorente T, López Hernández G, De la Gala Sánchez
F. Evolución de los reactantes de fase aguda y del metabolismo del hierro en artroscopia de rodilla por meniscopatía y en plastias
de ligamento cruzado anterior. Patología del Aparato Locomotor 2006;4(2):87-97.
17. Margheritini F, Camillieri G, Mancini L, Mariani PP. C-reactive protein and erythrocyte sedimentation rate changes following
arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2001;9(6):343-5.
18. Ruiz-Ibán AM, Diaz Heredia J, Cebreiro Martinez I, Alonso Güemes S, Cuellar Gutierrez R. Evolution of C-reactive
protein values in the first month alter anterior cruciate ligament reconstruction: reference values. Knee Surg Sports Traumatol
Arthrosc 2013;(11) [publicación en línea]
19. Gavriilidis I, Pakos EE, Wipfler B, Benetos IS, Paessler HH. Intra-operative hamstring tendon graft contamination in anterior
cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17(9):1043-7.
20. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J. Outcomes of postoperative septic arthritis after anterior cruciate
ligament reconstruction. Am J Sports Med 1999;27(5):562-70.