Therapeutic Strategies and Clinical Outcomes of Infections Following Anterior Cruciate Ligament Reconstruction: A Narrative Review

Abstract

Anterior cruciate ligament reconstruction (ACLR) is a widely performed orthopedic procedure, yet postoperative infection, although rare, poses a significant threat to graft integrity and long-term joint function. This review specifically focuses on therapeutic strategies for ACLR-associated infections. Management strategies constitute the core of this review, centering on early surgical debridement, targeted antimicrobial therapy, and, in selected cases, graft retention or removal. Preventive and rehabilitative measures such as graft presoaking with vancomycin, strict intraoperative asepsis, and structured postoperative rehabilitation are also discussed. Long-term functional outcomes are often suboptimal, emphasizing the importance of timely rehabilitation and individualized care. Rather than providing an exhaustive diagnostic review, we highlight therapeutic decision-making and evidence-based treatment pathways, supplemented by stratified comparisons of prospective and retrospective clinical studies. Ongoing research into biofilm-targeting therapies is essential to optimize treatment protocols and minimize infection-related complications.

Keywords

ACLR / postoperative infection / risk factors / treatment strategies

References

[1] R. H. Brophy and K. J. Lowry, “American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary: Management of Anterior Cruciate Ligament Injuries,” Journal of the American Academy of Orthopaedic Surgeons 31, no. 11 (2023): 531–537.

[2] A. M. Ptasinski, M. Dunleavy, T. Adebayo, and R. A. Gallo, “Returning Athletes to Sports Following Anterior Cruciate Ligament Tears,” Current Reviews in Musculoskeletal Medicine 15, no. 6 (2022): 616–628.

[3] M. Motififard, H. Akbari Aghdam, H. Ravanbod, et al., “Demographic and Injury Characteristics as Potential Risk Factors for Anterior Cruciate Ligament Injuries: A Multicentric Cross-Sectional Study,” Journal of Clinical Medicine 13, no. 17 (2024): 5063.

[4] M. M. Herzog, S. W. Marshall, J. L. Lund, V. Pate, C. D. Mack, and J. T. Spang, “Trends in Incidence of ACL Reconstruction and Concomitant Procedures Among Commercially Insured Individuals in the United States, 2002-2014,” Sports Health 10, no. 6 (2018): 523–531.

[5] D. Zhao, G. H. Liang, J. K. Pan, et al., “Risk Factors for Postoperative Surgical Site Infections After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis,” British Journal of Sports Medicine 57, no. 2 (2023): 118–128.

[6] J. L. Seidelman, C. R. Mantyh, and D. J. Anderson, “Surgical Site Infection Prevention: A Review,” Journal of the American Medical Association 329, no. 3 (2023): 244–252.

[7] N. Renz, T. Madjarevic, M. Ferrari, et al., “Recommendations on Diagnosis and Antimicrobial Treatment of Infections After Anterior Cruciate Ligament Reconstruction (ACL-R) Endorsed by ESSKA and EBJIS,” Journal of Infection 86, no. 6 (2023): 543–551.

[8] G. D. Cassano, L. Moretti, G. Vicenti, et al., “Infection After Anterior Cruciate Ligament Reconstruction: A Narrative Review of the Literature,” Healthcare (Basel, Switzerland) 12, no. 9 (2024): 894.

[9] J. G. Schneider, B. Ormseth, A. C. DiBartola, et al., “Incidence, Common Pathogens, and Risk Factors for Infection After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review,” Journal of Knee Surgery 37, no. 6 (2024): 470–481.

[10] A. J. H. Arundale, H. J. Silvers-Granelli, and G. Myklebust, “ACL Injury Prevention: Where Have We Come From and Where Are We Going?,” Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society 40, no. 1 (2022): 43–54.

[11] L. Zhang, R. Yang, Y. Mao, and W. Fu, “A Systematic Review and Meta-Analysis of Risk Factors for an Infection After Anterior Cruciate Ligament Reconstruction,” Orthopaedic Journal of Sports Medicine 11, no. 10 (2023): 200822.

[12] R. A. E. El-Kady and A. M. F. ElGuindy, “Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience From a Tertiary-Care Hospital,” Infection and Drug Resistance 15 (2022): 3779–3789.

[13] Z. Roecker, P. Kamalapathy, and B. C. Werner, “Male Sex, Cartilage Surgery, Tobacco Use, and Opioid Disorders Are Associated With an Increased Risk of Infection After Anterior Cruciate Ligament Reconstruction,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 38, no. 3 (2022): 948–952.e1.

[14] T. D. Kanneganti and V. D. Dixit, “Immunological Complications of Obesity,” Nature Immunology 13, no. 8 (2012): 707–712.

[15] L. T. Sørensen, S. Jørgensen, L. J. Petersen, et al., “Acute Effects of Nicotine and Smoking on Blood Flow, Tissue Oxygen, and Aerobe Metabolism of the Skin and Subcutis,” Journal of Surgical Research 152, no. 2 (2009): 224–230.

[16] J. M. Cancienne, F. W. Gwathmey, M. D. Miller, and B. C. Werner, “Tobacco Use Is Associated With Increased Complications After Anterior Cruciate Ligament Reconstruction,” American Journal of Sports Medicine 44, no. 1 (2016): 99–104.

[17] D. Zhao, J. K. Pan, F. Z. Lin, et al., “Risk Factors for Revision or Rerupture After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis,” American Journal of Sports Medicine 51, no. 11 (2023): 3053–3075.

[18] B. T. Samuelsen, K. E. Webster, N. R. Johnson, T. E. Hewett, and A. J. Krych, “Hamstring Autograft Versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-Analysis of 47,613 Patients,” Clinical Orthopaedics and Related Research 475, no. 10 (2017): 2459–2468.

[19] J. U. Barker, M. C. Drakos, T. G. Maak, R. F. Warren, R. J. Williams, and A. A. Allen, “Effect of Graft Selection on the Incidence of Postoperative Infection in Anterior Cruciate Ligament Reconstruction,” American Journal of Sports Medicine 38, no. 2 (2010): 281–286.

[20] G. B. Maletis, M. C. Inacio, S. Reynolds, J. L. Desmond, M. M. Maletis, and T. T. Funahashi, “Incidence of Postoperative Anterior Cruciate Ligament Reconstruction Infections: Graft Choice Makes a Difference,” American Journal of Sports Medicine 41, no. 8 (2013): 1780–1785.

[21] O. Ateş, I. Bozkurt, E. Uluyardimci, D. A. Öçgüder, and M. Uğurlu, “Relationship Between Graft Failure Following Anterior Cruciate Ligament Reconstruction and Hamstring Autograft Diameter,” Acta Orthopaedica Belgica 89, no. 3 (2023): 429–433.

[22] X. F. Zhang, P. Liu, J. W. Huang, and Y. H. He, “Efficacy and Safety of Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis,” Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology 25, no. 1 (2024): 65.

[23] H. D. Wang, Y. B. Zhu, T. R. Wang, W. F. Zhang, and Y. Z. Zhang, “Irradiated Allograft Versus Autograft for Anterior Cruciate Ligament Reconstruction: A Meta-Analysis and Systematic Review of Prospective Studies,” International Journal of Surgery (London, England) 49 (2018): 45–55.

[24] J. Hu, J. Qu, D. Xu, J. Zhou, and H. Lu, “Allograft Versus Autograft for Anterior Cruciate Ligament Reconstruction: An Up-To-Date Meta-Analysis of Prospective Studies,” International Orthopaedics 37, no. 2 (2013): 311–320.

[25] J. Wei, H. B. Yang, J. B. Qin, and T. B. Yang, “A Meta-Analysis of Anterior Cruciate Ligament Reconstruction With Autograft Compared With Nonirradiated Allograft,” Knee 22, no. 5 (2015): 372–379.

[26] P. D. Parchi, G. Ciapini, C. Paglialunga, et al., “Anterior Cruciate Ligament Reconstruction With LARS Artificial Ligament-Clinical Results After a Long-Term Follow-Up,” Joints 6, no. 2 (2018): 75–79.

[27] H. W. Mott, “Semitendinosus Anatomic Reconstruction for Cruciate Ligament Insufficiency,” Clinical Orthopaedics and Related Research 172 (1983): 90–92.

[28] T. Tiamklang, S. Sumanont, T. Foocharoen, and M. Laopaiboon, “Double-Bundle Versus Single-Bundle Reconstruction for Anterior Cruciate Ligament Rupture in Adults,” Cochrane Database of Systematic Reviews 11, no. 11 (2012): Cd008413.

[29] A. Gomez-Caceres, I. Tamimi-Mariño, F. J. Martinez-Malo, R. P. Idiart-Charrier, I. Vieitez-Riestra, and I. Medina-Porqueres, “Outcomes of “Over the Top” Anterior Cruciate Ligament Reconstruction Associated With a Lateral Extra-Articular Tenodesis in Children,” Journal of Clinical Medicine 13, no. 5 (2024): 1501.

[30] E. A. Özbek, P. W. Winkler, E. M. Nazzal, et al., “Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-The-Top and Transportal Drilling Techniques,” Orthopaedic Journal of Sports Medicine 11, no. 7 (2023): 1186972.

[31] R. Torres-Claramunt, X. Pelfort, J. Erquicia, et al., “Knee Joint Infection After ACL Reconstruction: Prevalence, Management and Functional Outcomes,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 21, no. 12 (2013): 2844–2849.

[32] J. Serna, N. Kucirek, K. Terada-Herzer, D. Lansdown, C. B. Ma, and A. L. Zhang, “Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis Is Associated With Reduced Risk for Revision Anterior Cruciate Ligament Reconstruction in an Insurance Claims Database,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 41, no. 9 (2025): 3425–3434.e1.

[33] E. Ayhan, H. Kesmezacar, and I. Akgun, “Intraarticular Injections (Corticosteroid, Hyaluronic Acid, Platelet Rich Plasma) for the Knee Osteoarthritis,” World Journal of Orthopedics 5, no. 3 (2014): 351–361.

[34] A. Najm, A. Alunno, J. M. Gwinnutt, C. Weill, and F. Berenbaum, “Efficacy of Intra-Articular Corticosteroid Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” Joint, Bone, Spine 88, no. 4 (2021): 105198.

[35] W. A. Cantrell, C. L. Cox, C. Johnson, et al., “The Effect of Aspiration and Corticosteroid Injection After ACL Injury on Postoperative Infection Rate,” American Journal of Sports Medicine 51, no. 14 (2023): 3665–3669.

[36] D. T. Rhode, M. A. Siegel, E. Volchenko, et al., “Do Intra-Articular Corticosteroid Injections Prior to Total Knee Arthroplasty Increase Postoperative Complication Rates: A Retrospective Review,” Journal of Knee Surgery 36, no. 3 (2023): 231–235.

[37] A. Guermazi, D. J. Hunter, and M. Kloppenburg, “Debate: Intra-Articular Steroid Injections for Osteoarthritis - Harmful or Helpful?(☆,☆☆),” Osteoarthritis Imaging 3, no. 3 (2023): 100163.

[38] J. S. Everhart, S. Yalcin, and K. P. Spindler, “Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data,” American Journal of Sports Medicine 50, no. 10 (2022): 2842–2852.

[39] S. M. Thompson, L. J. Salmon, A. Waller, J. Linklater, J. P. Roe, and L. A. Pinczewski, “Twenty-Year Outcome of a Longitudinal Prospective Evaluation of Isolated Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon or Hamstring Autograft,” American Journal of Sports Medicine 44, no. 12 (2016): 3083–3094.

[40] P. Schuster, M. Schlumberger, P. Mayer, et al., “Soaking of the Graft in Vancomycin Dramatically Reduces the Incidence of Postoperative Septic Arthritis After Anterior Cruciate Ligament Reconstruction,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 28, no. 8 (2020): 2587–2591.

[41] K. Banios, G. A. Komnos, V. Raoulis, M. Bareka, G. Chalatsis, and M. E. Hantes, “Soaking of Autografts With Vancomycin Is Highly Effective on Preventing Postoperative Septic Arthritis in Patients Undergoing ACL Reconstruction With Hamstrings Autografts,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 29, no. 3 (2021): 876–880.

[42] A. Carrozzo, A. Saithna, A. Ferreira, et al., “Presoaking ACL Grafts in Vancomycin Decreases the Frequency of Postoperative Septic Arthritis: A Cohort Study of 29,659 Patients, Systematic Review, and Meta-Analysis From the SANTI Study Group,” Orthopaedic Journal of Sports Medicine 10, no. 2 (2022): 73928.

[43] J. D. Lamplot, J. N. Liu, I. D. Hutchinson, et al., “Effect of Vancomycin Soaking on Anterior Cruciate Ligament Graft Biomechanics,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 37, no. 3 (2021): 953–960.

[44] A. Themessl, F. Mayr, K. Hatter, et al., “Patients Return to Sports and to Work After Successful Treatment of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 30, no. 6 (2022): 1871–1879.

[45] K. Tong, J. Wei, H. Gu, et al., “Evaluation of Experimental and Clinical Efficacy on Surgical Debridement and Systemic Antibiotics Treatment for Early Knee Infection After Anterior Cruciate Ligament Reconstruction,” Antimicrobial Agents and Chemotherapy 66, no. 6 (2022): e0011222.

[46] G. G. Costa, A. Grassi, M. Lo Presti, et al., “White Blood Cell Count Is the Most Reliable Test for the Diagnosis of Septic Arthritis After Anterior Cruciate Ligament Reconstruction: An Observational Study of 38 Patients,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 37, no. 5 (2021): 1522–1530.e2.

[47] M. T. Eisenberg, A. M. Block, M. L. Vopat, M. A. Olsen, and J. J. Nepple, “Rates of Infection After ACL Reconstruction in Pediatric and Adolescent Patients: A MarketScan Database Study of 44,501 Patients,” Journal of Pediatric Orthopedics 42, no. 4 (2022): e362–e366.

[48] Y. Ma, J. Guo, S. Lv, et al., “Standardized Treatment of Infection After Anterior Cruciate Ligament Reconstruction,” Scientific Reports 14, no. 1 (2024): 22332.

[49] D. Koh, S. M. Tan, and A. H. C. Tan, “Recurrent Surgical Site Infection After Anterior Cruciate Ligament Reconstruction: A Case Report,” World Journal of Orthopedics 10, no. 6 (2019): 255–261.

[50] S. Yao, B. S. Fu, and P. S. Yung, “Graft Healing After Anterior Cruciate Ligament Reconstruction (ACLR),” Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 25 (2021): 8–15.

[51] E. Konstantinou, T. Pfeiffer, M. S. Rocca, C. Grandberg, K. Dias, and V. Musahl, “Prevention and Management of Postoperative Infection After Anterior Cruciate Ligament Reconstruction: A Narrative Review,” Journal of Clinical Medicine 14, no. 2 (2025): 336.

[52] A. Runer, L. Keeling, N. Wagala, et al., “Current Trends in Graft Choice for Primary Anterior Cruciate Ligament Reconstruction - Part II: In-Vivo Kinematics, Patient Reported Outcomes, Re-Rupture Rates, Strength Recovery, Return to Sports and Complications,” Journal of Experimental Orthopaedics 10, no. 1 (2023): 40.

[53] S. Chittajallu, H. Gururani, S. Jakati, et al., “Investigation of Mechanical Strength and Structure of Corneal Graft-Host Junction,” Heliyon 10, no. 10 (2024): e30871.

[54] D. C. Flanigan, J. S. Everhart, A. C. DiBartola, et al., “Bacterial DNA Is Associated With Tunnel Widening in Failed ACL Reconstructions,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 27, no. 11 (2019): 3490–3497.

[55] D. Pérez-Prieto, T. Totlis, T. Madjarevic, et al., “ESSKA and EBJIS Recommendations for the Management of Infections After Anterior Cruciate Ligament Reconstruction (ACL-R): Prevention, Surgical Treatment and Rehabilitation,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 31, no. 10 (2023): 4204–4212.

[56] M. Attri, R. D'Ambrosi, L. Farinelli, et al., “ACL Reconstruction in Skeletally Immature Athletes: Current Concepts,” Medicina 61, no. 4 (2025): 562.

[57] L. Ferreira, E. Pos, D. R. Nogueira, F. P. Ferreira, R. Sousa, and M. A. Abreu, “Antibiotics With Antibiofilm Activity - Rifampicin and Beyond,” Frontiers in Microbiology 15 (2024): 1435720.

[58] M. Scarborough, H. K. Li, I. Rombach, et al., “Oral Versus Intravenous Antibiotics for Bone and Joint Infections: The OVIVA Non-Inferiority RCT,” Health Technology Assessment (Winchester) 23, no. 38 (2019): 1–92.

[59] M. E. Hantes, V. A. Raoulis, N. Doxariotis, A. Drakos, T. Karachalios, and K. N. Malizos, “Management of Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction Using a Standard Surgical Protocol,” Knee 24, no. 3 (2017): 588–593.

[60] R. Otchwemah, J. H. Naendrup, F. Mattner, T. Tjardes, H. Bäthis, and S. Shafizadeh, “Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection After Anterior Cruciate Ligament Reconstruction,” Journal of Knee Surgery 32, no. 11 (2019): 1111–1120.

[61] C. Wang, Y. Ao, J. Wang, Y. Hu, G. Cui, and J. Yu, “Septic Arthritis After Arthroscopic Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of Incidence, Presentation, Treatment, and Cause,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 25, no. 3 (2009): 243–249.

[62] B. R. Waterman, W. Arroyo, E. J. Cotter, M. A. Zacchilli, E. J. Garcia, and B. D. Owens, “Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal,” Orthopaedic Journal of Sports Medicine 6, no. 3 (2018): 2325967118758626.

[63] K. Srivastava, K. J. Bozic, C. Silverton, A. J. Nelson, E. C. Makhni, and J. J. Davis, “Reconsidering Strategies for Managing Chronic Periprosthetic Joint Infection in Total Knee Arthroplasty: Using Decision Analytics to Find the Optimal Strategy Between One-Stage and Two-Stage Total Knee Revision,” Journal of Bone and Joint Surgery American Volume 101, no. 1 (2019): 14–24.

[64] F. Bottner, A. Wegner, W. Winkelmann, K. Becker, M. Erren, and C. Götze, “Interleukin-6, Procalcitonin and TNF-Alpha: Markers of Peri-Prosthetic Infection Following Total Joint Replacement,” Journal of Bone and Joint Surgery. British Volume 89, no. 1 (2007): 94–99.

[65] J. K. Antonios, K. J. Bozic, H. D. Clarke, M. J. Spangehl, J. S. Bingham, and A. J. Schwartz, “Cost-Effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model,” Arthroplasty Today 11 (2021): 187–195.

[66] Q. Ding, Y. Xie, K. Xiong, et al., “From Light to Cure: Precision Phototherapies for Antibiotic-Refractory Biofilm Infections,” Angewandte Chemie (International Ed. in English) 64, no. 43 (2025): e202510900.

[67] M. Depypere, R. Kuehl, W. J. Metsemakers, et al., “Recommendations for Systemic Antimicrobial Therapy in Fracture-Related Infection: A Consensus From an International Expert Group,” Journal of Orthopaedic Trauma 34, no. 1 (2020): 30–41.

[68] F. Figueroa, D. Figueroa, R. Calvo, A. Vaisman, M. Nuñez, and S. Putnis, “Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis,” HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery 18, no. 1 (2022): 138–144.

[69] A. W. Serio, T. Keepers, L. Andrews, and K. M. Krause, “Aminoglycoside Revival: Review of a Historically Important Class of Antimicrobials Undergoing Rejuvenation,” EcoSal Plus 8, no. 1 (2018): e11281.

[70] S. Dhole, C. Mahakalkar, S. Kshirsagar, and A. Bhargava, “Antibiotic Prophylaxis in Surgery: Current Insights and Future Directions for Surgical Site Infection Prevention,” Cureus 15, no. 10 (2023): e47858.

[71] R. N. Puzzitiello, S. E. Lipson, R. G. Michaud, et al., “Effect of Antibiotic Administration Before Joint Aspiration on Synovial Fluid White Blood Cell Count in Native Joint Septic Arthritis,” Open Forum Infectious Diseases 11, no. 1 (2024): ofad600.

[72] C. L. Ardern, G. Ekås, H. Grindem, et al., “2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis and Management of Paediatric Anterior Cruciate Ligament (ACL) Injuries,” Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA 26, no. 4 (2018): 989–1010.

[73] S. E. Lemos, P. M. Keating, T. P. Scott, and R. M. Siwiec, “Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal,” Arthroscopy Techniques 2, no. 4 (2013): e483–e490.

[74] K. H. Yoon, S. M. Lee, J. Y. Park, H. S. Lee, and S. H. Hwang, “A Comparison of Results in Older, Middle-Aged, and Younger Patients After Primary Anterior Cruciate Ligament Reconstruction: Minimum 10-Year Follow-Up,” Clinics in Orthopedic Surgery 16, no. 1 (2024): 57–65.

[75] C. W. Tan, W. H. Hsu, P. A. Yu, et al., “Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Systematic Review and Meta-Analysis,” Orthopaedic Journal of Sports Medicine 8, no. 4 (2020): 915698.

[76] D. Zhang, J. Cheng, D. Cao, and K. Sheng, “Innate Immunosenescence and Sepsis in the Elderly: Mechanisms and Innate Immune Modulation Strategies,” Central-European Journal of Immunology 50, no. 1 (2025): 3–10.

[77] M. A. Salesky, J. F. Oeding, A. L. Zhang, C. B. Ma, B. T. Feeley, and D. A. Lansdown, “Patients Aged 50 Years and Older Have Greater Complication Rates After Anterior Cruciate Ligament Reconstruction: A Large Database Study,” Arthroscopy, Sports Medicine, and Rehabilitation 3, no. 6 (2021): e1827–e1834.

[78] J. Gille, V. Körner, R. Oheim, et al., “Dynamic Postural Stability After Cartilage Repair in the Knee,” Open Orthopaedics Journal 16, no. 1 (2022): e187432502206300.

[79] A. Abdel-Aziz, Y. A. Radwan, and A. Rizk, “Multiple Arthroscopic Debridement and Graft Retention in Septic Knee Arthritis After ACL Reconstruction: A Prospective Case-Control Study,” International Orthopaedics 38, no. 1 (2014): 73–82.

[80] H. Boström Windhamre, C. Mikkelsen, M. Forssblad, and L. Willberg, “Postoperative Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Does It Affect the Outcome? A Retrospective Controlled Study,” Arthroscopy: The Journal of Arthroscopic & Related Surgery: Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association 30, no. 9 (2014): 1100–1109.

[81] D. R. Lee, E. Therrien, B. M. Song, et al., “Arthrofibrosis Nightmares: Prevention and Management Strategies,” Sports Medicine and Arthroscopy Review 30, no. 1 (2022): 29–41.

RIGHTS & PERMISSIONS

2026 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.