Male Sex, Cartilage Surgery, Tobacco Use, and Opioid Disorders are Associated with an Increased Risk of Infection After Anterior Cruciate Ligament Reconstruction

Purpose: To identify patient-related risk factors for infection following anterior cruciate ligament reconstruction (ACLR). Methods: The Mariner database within PearlDiver was queried for patients from 2010 to 2019 undergoing primary arthroscopic ACLR. Patients undergoing ACLR with concomitant open surgery or additional ligament reconstructions were excluded. Postoperative diagnoses or procedures for superficial or deep infection within 6 months were assessed. A multivariable logistic regression analysis was then used to evaluate patient-related risk factors for postoperative infection. Adjusted odds ratios (OR) and 95% confidence intervals (CIs) were calculated for each risk factor, with P<.05 considered statistically significant. Results: In total, 217,541 patients underwent ACLR and 1779 (0.8%) patients had a postoperative infection within 6 months. Significant independent risk factors included male sex (OR 1.58, 95% CI 1.43-1.75, P<.001), obesity (OR 1.22, 95% CI 1.05-1.43, P=.020), morbid obesity (OR 2.54, 95% CI 2.11-3.06, P=.002), tobacco use (OR 1.36, 95% CI 1.19-1.55, P<.001), age younger than 40 years (OR 1.21,95% CI 1.07-1.37, P=.033), depression (OR 1.18,95% CI 1.04-1.34, P=.012), opioid disorder (OR 1.50, 95% CI 1.22-1.85, P<.001), concomitant simple cartilage surgery (OR 1.63, 95% CI 1.43-1.86, P<.001), and complex cartilage surgery (OR 1.67,95% CI 1.20-2.32, P=.002). Partial meniscectomy and meniscal repair at the time of ACLR were not associated with an increased risk of infection. Conclusions: In a large national sample, male sex, obesity, tobacco use, older age, depression, opioid disorders and concomitant cartilage surgery were significant risk factors for infection following ACLR.