Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction

Gavriilidis, Iosif; Pakos, Emilios E.; Wipfler, Benjamin; Benetos, Ioannis S.; Paessler, Hans H.

doi:10.1007/s00167-009-0836-7

Cited by 21 publications

(34 citation statements)

References 28 publications

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“…Soft tissue injuries involved in harvesting the tendons and creating a tibial tunnel and the use of an additional metallic post, washer, and braided sutures in subcutaneous position could be the causes of wound complications. Hantes et al8) and Gavriilidis et al9) reported a 10% infection rate associated with intraoperative graft contamination, especially in the autologous hamstring tendon. Based on these reports, the hamstring tendon used in all cases in our study could have been the source of infection.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

Kim

Lee

et al. 2017

Knee Surg Relat Res

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PurposeWe encountered 7 cases (7.1%) of infection (5 deep and 2 superficial) in 98 cases of anterior cruciate ligament (ACL) reconstruction using hamstring autografts in a 17-month period. The aim of this study was to analyze the causes of infection and to introduce our treatment strategy.Materials and MethodsWe investigated the shelf-life of the fixation implants, the order of surgery, previous knee surgery, infectious pathogen, treatment of infection, and results of treatment.ResultsThere was no problem with the expiration date of the fixation implants. The order of surgery was either the last or second to the last of all those performed on the same day. One patient had undergone knee surgery 8 months previously. The treatment after infection included aggressive debridement in all cases. Revision ACL reconstruction with graft removal was performed in 1 case of persistent infection with methicillin-resistant Staphylococcus aureus. All cases had satisfactory clinical results without recurrence during a mean 24.9 months of follow-up.ConclusionsWe could not verify the exact cause of the high incidence of infection during the 17-month period. However, preventive measures are important to decrease the incidence of infection after ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

Kim

Lee

et al. 2017

Knee Surg Relat Res

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“…About 60% of tissue samples that fall to the ground have positive bacterial cultures. 18 Contamination can also occur without dropping the graft, as shown at a level II study, 19 in which 12% of ACL autografts were contaminated during preparation for reconstruction. 19 In the case-control study by Abdel-Aziz et al 20 infection was controlled in all cases without graft sacrifice.…”

Section: Discussionmentioning

confidence: 99%

Descontaminação transoperatória de enxerto durante cirurgia de reconstrução do LCA

Luciano¹,

Macedo²,

Pereira³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Objective To evaluate different decontaminants for tendon grafts, proposing an antiseptic protocol for contaminated grafts. Methods A total of 25 patients were tissue donors for the study. Each participant donated a 2.5-cm tendon sample, which was divided into 5 fragments with 5 mm each during anterior cruciate ligament (ACL) reconstruction surgery. The collected material was divided into 5 groups, totaling 125 samples. In total, four fragments of each patient were placed on the operating room floor for one minute for contamination, simulating the fall of the graft on the floor during surgery. The other fragment was immediately placed in a sterile container (group 1). One of the contaminated fragments was placed in the sterile container without being previously immersed in decontaminating solution (group 2). The remaining fragments were immersed for ten minutes in decontaminating solution: 0.5% chlorhexidine (group 3), 0.9% saline (group 4) and 0.55% ortho-phthalaldehyde (group 5), and, after this time, they were individually placed in a sterile container. The samples from the 5 groups were submitted to microbiological examination. Results Bacteria were detected in 26% of the total samples in the microbiological tests, and in group 1 there was no growth of microorganisms. In group 2, bacterial growth was observed in 16 samples. Considering the evaluation of test groups 3, 4 and 5, the percentage of decontamination was higher than the growth of microorganisms in the respective cultures. Conclusion The protocol suggested by the study showed that intraoperative graft decontamination is possible.

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“…Una de sus conclusiones fue que a mayor daño tisular, mayores valores máximos absolutos de PCR. 15 En otro estudio, Gavriilidis 19 observó que la contaminación de autoinjertos de isquiotibiales durante su preparación en quirófano está relacionada con una elevación mayor de la PCR al cuarto día, estadísticamente significativa en comparación con los no contaminados (los autores sostienen que este resultado puede estar sesgado por el escaso número de contaminaciones de injertos), aunque esto no se corresponda con un diagnóstico clínico de artritis séptica.…”

Section: Tabla 2 Análisis De La Evolución En El Tiempo De Los Marcadunclassified

“…Se han descrito numerosos factores como causa de una mayor tasa de infección posoperatoria en la reconstrucción de LCA: el autoinjerto de isquiotibiales comparado con hueso-tendón-hueso, 4 debido al mayor tiempo de preparación, 19 la fijación de injerto de isquiotibiales con material exógeno (ENDOBUTTON) y la mayor disección de partes blandas en estos pacientes, 9 el sexo masculino, los aloinjertos comparado con autoinjertos, 4 la "esterilización flash", 3,4 una cirugía previa.…”

Section: Tabla 2 Análisis De La Evolución En El Tiempo De Los Marcadunclassified

Evolución de los reactantes de fase aguda tras la reconstrucción no complicada del ligamento cruzado anterior por vía artroscópica. [Inflammatory blood marker patterns following uncomplicated arthroscopically-assisted anterior cruciate ligament reconstruction.]

Prado¹,

Teixeira²,

Flores³

et al. 2015

Rev. Asoc. Arg. Ort. y Traumatol

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Rev Asoc Argent Ortop Traumatol 70 ResumenIntroducción: El objetivo de este estudio fue determinar los niveles de los principales reactantes de fase aguda (proteína C reactiva y eritrosedimentación) en el posoperatorio de una reconstrucción artroscópica del ligamento cruzado anterior sin complicaciones y analizar si diferentes variables del tratamiento realizado podrían alterar esos valores. Materiales y Métodos: Se llevó a cabo un estudio prospectivo de todas las reconstrucciones del ligamento cruzado anterior realizadas en nuestro Hospital, entre diciembre de 2012 y diciembre de 2013. Los niveles en sangre de proteína C reactiva, eritrosedimentación y leucocitos fueron determinados un día antes de la intervención, y a las 24 horas y a los 15 y 30 días de la cirugía. Se recogieron diferentes variables de la intervención: tiempo de isquemia, tiempo de cirugía, tipo de injerto y diferentes gestos asociados a la reconstrucción (sutura meniscal, microfracturas, etc.). Resultados: De los tres reactantes analizados, la proteína C reactiva es la que presenta un ascenso más elevado en el posoperatorio, es la única que vuelve a valores basales a los 30 días de la intervención (p >0,05). En cuanto a las variables analizadas, sólo el tiempo de isquemia se relacionaba con valores más elevados de proteína C reactiva. Conclusiones: La monitorización de la proteína C reactiva es una prueba práctica y sensible para detectar complicaciones después de la cirugía de ligamento cruzado anterior. Ante valores elevados a partir de los 15 días y si existe sospecha de infección debe realizarse una punción articular.Palabras clave: Ligamento cruzado anterior. Proteína C reactiva. Artritis séptica. Nivel de evidencia: IV Inflammatory blood marker patterns following uncomplicated arthroscopically-assisted anterior cruciate ligament reconstruction AbstractBackground: The 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 variable of surgical treatment alter this blood marker. Methods: A prospective review was conducted including all anterior cruciate ligament reconstructions 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 at 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.

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Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction

Cited by 21 publications

References 28 publications

Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

Evaluation of Infection after Anterior Cruciate Ligament Reconstruction during a Short Period

Descontaminação transoperatória de enxerto durante cirurgia de reconstrução do LCA

Evolución de los reactantes de fase aguda tras la reconstrucción no complicada del ligamento cruzado anterior por vía artroscópica. [Inflammatory blood marker patterns following uncomplicated arthroscopically-assisted anterior cruciate ligament reconstruction.]

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