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Chondrolysis of the Tibial Plateau Caused by Articular Aspergillosis After ACL Autograft Reconstruction: Management with a Fresh Osteochondral Allograft

Arthroscopically assisted reconstruction of the anterior cruciate ligament (ACL) is a common and effective method for treatment of anterior knee instability following ACL injury. Annually, an estimated 250,000 ACL injuries are diagnosed and approximately 100,000 ACL reconstructions are performed in the United States 1 - 3 . Chondrolysis is an extremely rare but devastating complication following ACL reconstruction. It is characterized by complete destruction of the articular cartilage and a profound inflammatory response consisting of pain, swelling, and loss of joint motion. The differential diagnosis includes osteonecrosis, direct trauma related to the injury or to the surgical procedure, infection, an adverse reaction to pharmacological agents (including local anesthetic infusions), and unknown causes. Infection after arthroscopic ACL reconstruction is rare: its incidence has been reported as 0.14% to 1.7% 2 , 4 - 7 . The most common causative organisms are Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus haemolyticus 2 , 4 - 6 . When tissue allografts have been used for ACL reconstruction, other organisms such as Peptostreptococcus, Klebsiella, Enterobacter, and Clostridium species as well as gram-negative bacilli have been implicated 6 , 8 . Although infrequent, infection can be a devastating complication that leads to septic arthritis, chondrolysis, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Bone and Joint Surgery JB&JS
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