Treatment of Postoperative Anterior Cruciate Ligament Infections with Graft Removal and Early Reimplantation

Burks, Robert T.; Friederichs, Matthew G.; Fink, Barbara P.; Luker, Mark G.; West, Hugh S.; Greis, Patrick E.

doi:10.1177/03635465030310031501

Cited by 132 publications

(179 citation statements)

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“…aureus and CNS (S. epidermidis and other coagulasenegative species) are the most common bacteria found in most series [2,3,5,7,10,11,[14][15][16]. Additionally, different methicillin-resistant S. aureus or anaerobium microorganisms have also been cultured as the origin of such infections.…”

Section: Aetiopathologymentioning

confidence: 99%

“…Additionally, different methicillin-resistant S. aureus or anaerobium microorganisms have also been cultured as the origin of such infections. This fact should be considered when empirical antibiotic treatment is initiated [3,14]. Staphylococcus is a microorganism capable of forming a biofilm within the first few weeks that protects itself from antimicrobials, thus making it difficult to eradicate [17].…”

Section: Aetiopathologymentioning

confidence: 99%

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Managing septic arthritis after knee ligament reconstruction

Torres-Claramunt

Gelber

Pelfort

et al. 2015

International Orthopaedics (SICOT)

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Section: Aetiopathologymentioning

confidence: 99%

Section: Aetiopathologymentioning

confidence: 99%

Managing septic arthritis after knee ligament reconstruction

Torres-Claramunt

Gelber

Pelfort

et al. 2015

International Orthopaedics (SICOT)

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“…Septic arthrosis is a rare but potentially devastating complication after ACL reconstruction, with rates reported between 0.14% and 1.7% [5,9,13,[15][16][17]. The choice of graft selected for ACL reconstruction may increase the risk of infection, with several studies reporting a higher incidence of infection with hamstring tendon autografts compared with bone-patella-tendon-bone autografts and allografts [4,10,11].…”

Section: Introductionmentioning

confidence: 99%

The In Vitro Elution Characteristics of Vancomycin from Tendons

Grayson

Grant

Dukie

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Infection after ACL reconstruction is uncommon but catastrophic. Prophylactic graft saturation in vancomycin reportedly reduces infection rates. Questions/purposes We characterized vancomycin elution from soaked tendons. Specifically, the effect of rinsing was studied. We also determined how vancomycin concentration in the soak solution and tendon dimension influenced this elution rate, and examined whether the vancomycin amount released was lower than osteoblast and chondroblast toxic concentrations. Methods Bovine tendons were wrapped in sterile gauze swabs presoaked with 5-, 2.5-, or 1.25-mg/mL vancomycin solutions. After 10 minutes, rinsed and unrinsed tendons were placed in 100 mL agitated 37°C phosphate-buffered saline (PBS). One-milliliter samples taken at 10 minutes and 1, 6, 12, 24, and 72 hours were analyzed by highperformance liquid chromatography. ResultsThe maximum elution rate occurred between 10 minutes and 1 hour, with no lag between experiment initiation and drug appearance in the solution. Rinsing affected the initial amount in solution but had little influence on drug release after 10 minutes. Vancomycin diffusion rates were dependent on soak solution concentration at all sampling intervals. The vancomycin amount released or eluted did not increase after the 1-hour interval. At 24 hours, concentrations were 45 ± 12, 16 ± 1, and 9 ± 3 lg/mL for the 5-, 2.5-, and 1.25-mg/mL solutions, respectively. Higher elution rates were observed in largervolume tendons. Conclusions Soaked tendon grafts can act as reservoirs for vancomycin, with the amount released and elution profile dependent on rinsing, tendon volume, and soak solution concentration. Vancomycin elution was lower than previously reported osteoblast and chondroblast toxicity concentrations and above the minimum inhibitory concentration for Staphylococcus. Clinical Relevance Presoaking ACL reconstruction autografts with vancomycin may reduce the risk of ACL reconstruction infection without the risk of local or general toxicity.

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“…Clinical signs and laboratory tests that can substantiate clinical suspicion include joint effusion, pain at wound and with knee motion, erythema, drainage and fever, elevated white blood cell (WBC) count, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (6)(7)(8). However, a definite diagnosis can be made when pathogens are found in cultured aspirates and/or in intra-operative tissue cultures (5)(6)(7)(8)(9). Microorganisms reported to be responsible for ACL surgery-related infections include both gram-positive and gram-negative bacteria (6)(7)(8)(9).…”

mentioning

confidence: 99%

“…However, a definite diagnosis can be made when pathogens are found in cultured aspirates and/or in intra-operative tissue cultures (5)(6)(7)(8)(9). Microorganisms reported to be responsible for ACL surgery-related infections include both gram-positive and gram-negative bacteria (6)(7)(8)(9). The fanner are most commonly represented by Staphylococcus aureus and coagulase-negative staphylococci such as Staphylococcus epidermidis as well as by Propionibacterium acnes and Corynebacterium.…”

mentioning

confidence: 99%

Clinical and Laboratory Changes in the Uncomplicated Course of Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction: A Prospective Observational Study in 58 Patients

Calvisi¹,

Lupparelli²,

Rossetti³

et al. 2008

Eur J Inflamm

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Knowledge of post-operative clinical and laboratory changes in the uncomplicated course of ACL reconstruction could assist orthopaedic surgeons in making a timely diagnosis of septic arthritis. A total of 58 candidates to ACL reconstruction were enrolled in this study according to inclusion/exclusion criteria. Pre-and post-operative changes on I", 3 rd , T", 15 th, and 30 t h day were collected for skin body temperature (SBT), knee pain (KP), white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Post-operative joint effusion was recorded when inhibiting quadriceps contraction. The post-operative changes were compared with baseline values at each time point in the whole sample and in the subgroups of patients receiving bone-patellar-tendon-bone (BPTP) or hamstring tendon (HT) autograft. Follow-up at six month was considered adequate to rule out surgery-related septic arthritis. Mean SBT significantly increased on I", 3 r d and 7 th post-operative day and returned to values not differing from baseline on 15 t h and 30 t h day. Median KP was significantly elevated during the first month. Joint effusion was observed on 7 t h post-operative day in 52% of patients. Mean WBC count significantly increased on 1'1, T" and 15 t h day while no difference from baseline was observed on 3 rd and 30 th day. Mean ESR was significantly elevated on I" day, increased on 3 rd day and peaked on 7 th day. ESR decreased on 15 t h and 30 th day but remained significantly higher than baseline. Mean CRP significantly increased on 1st day, peaked on 3 rd day and decreased on 7 t h day, while levels on 15 th and 30 th day did not differ from baseline. The SBT, KP, WBC count, ESR and CRP changes stratified in relation to the type of autograft showed the same variation trend as in the whole sample. Close clinical surveillance may be advisable when SBT, occurrence of joint effusion and CRP levels deviate from the described reference trend two weeks after surgery.Although the natural history of ACL-insufficient knees is unclear (1-2), it is generally agreed that recurrent episodes of symptomatic instability would lead to an accrual ofjoint damage (l , 3), particularly if a meniscectomy has been performed following ACLtear (4). The indication for ACL reconstruction includes the desire of recreational or professional athletes to return promptly to the pre-injury activity level or the persistence of symptomatic instability following rehabilitation and activity level modifications (l, 3).The onset of septic arthritis, the reported rate of

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Treatment of Postoperative Anterior Cruciate Ligament Infections with Graft Removal and Early Reimplantation

Abstract: Graft removal after confirmed anterior cruciate ligament graft infection and intravenous antibiotic administration followed by early graft reimplantation can give excellent results.

Cited by 132 publications

References 20 publications

Managing septic arthritis after knee ligament reconstruction

Managing septic arthritis after knee ligament reconstruction

The In Vitro Elution Characteristics of Vancomycin from Tendons

Clinical and Laboratory Changes in the Uncomplicated Course of Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction: A Prospective Observational Study in 58 Patients

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