Graft salvage following infected anterior cruciate ligament reconstruction

Kuršumović, Kenan; Charalambous, Charalambos Panayiotou

doi:10.1302/0301-620x.98b5.35990

Cited by 34 publications

(29 citation statements)

References 35 publications

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“…Joint instability can result in pain and dysfunction and ultimately the development of OA. 27 Injury to the ACL is common, particularly in the young adult population. 28 In a long-term cohort study, it was reported that patients who sustained an ACL injury were at a substantially increased risk for the development of secondary OA in both patellofemoral and tibiofemoral joints.…”

Section: Discussionmentioning

confidence: 99%

Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models

Tawonsawatruk

Sriwatananukulkit

Himakhun

et al. 2018

Bone & Joint Research

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ObjectivesIn this study, we compared the pain behaviour and osteoarthritis (OA) progression between anterior cruciate ligament transection (ACLT) and osteochondral injury in surgically-induced OA rat models.MethodsOA was induced in the knee joints of male Wistar rats using transection of the ACL or induction of osteochondral injury. Changes in the percentage of high limb weight distribution (%HLWD) on the operated hind limb were used to determine the pain behaviour in these models. The development of OA was assessed and compared using a histological evaluation based on the Osteoarthritis Research Society International (OARSI) cartilage OA histopathology score.ResultsBoth models showed an increase in joint pain as indicated by a significant (p < 0.05) decrease in the values of %HLWD at one week post-surgery. In the osteochondral injury model, the %HLWD returned to normal within three weeks, while in the ACLT model, a significant decrease in the %HLWD was persistent over an eight-week period. In addition, OA progression was more advanced in the ACLT model than in the osteochondral injury model. Furthermore, the ACLT model exhibited a higher mean OA score than that of the osteochondral injury model at 12 weeks.ConclusionThe development of pain patterns in the ACLT and osteochondral injury models is different in that the OA progression was significant in the ACLT model. Although both can be used as models for a post-traumatic injury of the knee, the selection of appropriate models for OA in preclinical studies should be specified and relevant to the clinical scenario.Cite this article: T. Tawonsawatruk, O. Sriwatananukulkit, W. Himakhun, W. Hemstapat. Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models. Bone Joint Res 2018;7:244–251. DOI: 10.1302/2046-3758.73.BJR-2017-0121.R2.

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Section: Discussionmentioning

confidence: 99%

Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models

Tawonsawatruk

Sriwatananukulkit

Himakhun

et al. 2018

Bone & Joint Research

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“…A recent meta-analysis found a graft preservation rate of 86% considering the results of 147 patients. 10 Data of 16 studies were pooled, of which the largest one included 27 patients. No specific information about the severity of joint space infection was given.…”

Section: Discussionmentioning

confidence: 99%

Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

Otchwemah

Naendrup

Mattner³

et al. 2018

J Knee Surg

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Knee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ± 9.9) years and admitted 14 ( ± 7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

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“… 1 2 3 4 5 Multiple factors including surgical technique, graft type (semitendinosus and gracilis [STG], quadriceps, bone–patellar tendon–bone [BPTB]), graft source (autograft, allograft), fixation technique (cortical fixation, bio-screws), diabetes mellitus, smoking, intraarticular steroid injection, obesity, etc., have been reported as potential risk factors for postoperative infections. 4 5 6 7 8 9 10 Further, there are varied treatment protocols used by various authors including conservative treatment, open or arthroscopic debridement with graft retention or graft removal. 2 3 4 5 11 However, most of these series are small case series with no well-defined guidelines.…”

Section: Introductionmentioning

confidence: 99%

“… 2 3 4 5 11 However, most of these series are small case series with no well-defined guidelines. 1 2 3 4 5 6 7 …”

Section: Introductionmentioning

confidence: 99%

“…The majority of reports of infection after ACLRS have originated from the Caucasian population with a few reports from the Asian population. 6 7 8 9 10 11 12 Different ethnic populations can have varied predisposition to infections, in terms of type and virulence of organisms. 13 Thus, there is a need to have more data from different ethnic populations.…”

Section: Introductionmentioning

confidence: 99%

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Incidence, Risk Factors, and Management of Infection Following Anterior Cruciate Ligament Reconstruction Surgery

Gupta

Sood

Malhotra

et al. 2018

IJOO

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Background:Infection after anterior cruciate ligament reconstruction surgery (ACLRS) is a rare complication. Although there are number of studies from various Caucasian population but only few studies are available from Asian population. The aim of the study is to assess the incidence, risk factors and, clinical outcome using our treatment protocol.Materials and Methods:Out of 1468 arthroscopic ACLRS, 26 patients with clinical suspicion of infection were critically analysed in terms of laboratory reports of arthrocentesis, erythrocyte sedimentation rate, C-reactive protein and risk factors such as the type of graft, gender, diabetes mellitus, smoking, intraarticular steroid injection, and obesity. At final followup, all these patients were evaluated using visual analog scale (VAS), Lysholm knee score, and Tegner activity level.Results:In nine patients, culture did not show any growth and they showed improvement with arthrocentesis and oral antibiotics. These patients were labeled as suffering from aseptic effusion. In the remaining 17 patients, there was no clinical improvement or instead worsening of symptoms after arthrocentesis and oral antibiotics. These patients were labeled as suffering from an infection and underwent surgical debridement along with administration of injectable antibiotics. The history of intraarticular steroid injection before ACLRS was a significant risk factor for developing infection (P = 0.001). At mean followup of 2.8 years, mean VAS improved to 1.18 ± 0.99 from 6.2 ± 2.3. The mean Lysholm knee score and Tegner's activity level at the final followup were 79.2 ± 10.52 and 4.8 ± 2.30, respectively.Conclusion:The incidence of infection was 1.2% (17/1468). The step-ladder approach of differentiating between aseptic effusion and infection and accordingly, following a treatment protocol, i.e., oral antibiotics alone or surgical debridement along with injectable antibiotics or additional debridement of graft in refractory patients, yielded satisfactory results.

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Graft salvage following infected anterior cruciate ligament reconstruction

Abstract: Arthroscopic debridement combined with antibiotic therapy is an appropriate initial approach in most cases of septic arthritis following ACL reconstruction, achieving graft salvage rates of about 85%. Cite this article: Bone Joint J 2016;98-B:608-15.

Cited by 34 publications

References 35 publications

Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models

Comparison of pain behaviour and osteoarthritis progression between anterior cruciate ligament transection and osteochondral injury in rat models

Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

Incidence, Risk Factors, and Management of Infection Following Anterior Cruciate Ligament Reconstruction Surgery

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