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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 17, Issue 9, pp 1043–1047 | Cite as

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

  • Iosif Gavriilidis
  • Emilios E. PakosEmail author
  • Benjamin Wipfler
  • Ioannis S. Benetos
  • Hans H. Paessler
Knee

Abstract

We aimed to evaluate the possibility of hamstring tendon contamination, the correlation with clinical infection and its association with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in 89 anterior cruciate ligament reconstructions. Two tissue samples were obtained for culture from each graft: immediately after harvesting the graft and before implantation. The ESR and the CRP were evaluated preoperatively and on the 4th and 20th postoperative days. Nine patients (10%) had positive cultures but no patient had signs of postoperative infection. All patients had ESR and CRP values elevated at the 4th postoperative day. ESR and CRP values returned to normal levels at the 20th postoperative day. Higher mean values of CRP levels at the 4th day were observed in patients with contaminated grafts compared to those with uncontaminated. Both values reached normal levels at the 20th postoperative day.

Keywords

Anterior cruciate ligament Reconstruction Hamstring graft Graft contamination Infection 

References

  1. 1.
    Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8:213–223. doi: 10.1016/0749-8063(92)90039-E PubMedGoogle Scholar
  2. 2.
    Atkins BL, Athanasou N, Deeks JJ et al (1998) Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 36:2932–2939PubMedGoogle Scholar
  3. 3.
    Binnet MS, Başarir K (2007) Risk and outcome of infection after different arthroscopic anterior cruciate ligament reconstruction techniques. Arthroscopy 23:862–868. doi: 10.1016/j.arthro.2007.02.008 PubMedCrossRefGoogle Scholar
  4. 4.
    Blevins FT, Salgado J, Wascher DC et al (1999) Septic arthritis following arthroscopic meniscus repair: a cluster of three cases. Arthroscopy 15:35–40. doi: 10.1053/ar.1999.v15.015003 PubMedGoogle Scholar
  5. 5.
    Burd T, Conroy BP, Meyer SC et al (2000) The effects of chlorhexidine irrigation solution on contaminated bone-tendon allografts. Am J Sports Med 28:241–244PubMedGoogle Scholar
  6. 6.
    Centeno JM, Woolf S, Reid JB III et al (2007) Do anterior cruciate ligament allograft culture results correlate with clinical infections? Arthroscopy 23:1100–1103. doi: 10.1016/j.arthro.2007.05.006 PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper DE, Arnoczky SP, Warren RF (1991) Contaminated patellar tendon grafts: incidence of positive cultures and efficacy of an antibiotic solution soak—an in vitro study. Arthroscopy 7:272–274. doi: 10.1016/0749-8063(91)90125-H PubMedGoogle Scholar
  8. 8.
    Davis N, Curry A, Gambhir AK et al (1999) Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br 81:886–889. doi: 10.1302/0301-620X.81B5.9545 PubMedCrossRefGoogle Scholar
  9. 9.
    Diaz-de Rada P, Barriga A, Barroso JL et al (2003) Positive culture in allograft ACL-reconstruction: what to do? Knee Surg Sports Traumatol Arthrosc 11:219–222. doi: 10.1007/s00167-003-0385-4 PubMedCrossRefGoogle Scholar
  10. 10.
    Frank M, Schmucker U, David S et al (2008) Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:71–74. doi: 10.1007/s00167-007-0424-7 PubMedCrossRefGoogle Scholar
  11. 11.
    Goebel ME, Drez D Jr, Heck SB et al (1994) Contaminated rabbit patellar tendon grafts. In vivo analysis of disinfecting methods. Am J Sports Med 22:387–391. doi: 10.1177/036354659402200315 PubMedCrossRefGoogle Scholar
  12. 12.
    Hantes ME, Basdekis GK, Varitimidis SE et al (2008) Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am 90:760–764. doi: 10.2106/JBJS.G.00806 PubMedCrossRefGoogle Scholar
  13. 13.
    Hogan CJ, Fang GD, Scheld WM et al (2001) Inhibiting the inflammatory response in joint sepsis. Arthroscopy 17:311–315. doi: 10.1053/jars.2001.21492 PubMedGoogle Scholar
  14. 14.
    Judd D, Bottoni C, Kim D et al (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22:375–384. doi: 10.1016/j.arthro.2005.12.002 PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly PJ, Martin WJ, Coventry MB (1970) Bacterial (suppurative) arthritis in the adult. J Bone Joint Surg Am 52:1595–1602PubMedGoogle Scholar
  16. 16.
    Kobayashi N, Procop GW, Krebs V et al (2008) Molecular identification of bacteria from aseptically loose implants. Clin Orthop Relat Res 466:1716–1725. doi: 10.1007/s11999-008-0263-y PubMedCrossRefGoogle Scholar
  17. 17.
    Margheritini F, Camillieri G, Mancini L et al (2001) C-reactive protein and erythrocyte sedimentation rate changes following arthroscopically assisted anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 9:343–345. doi: 10.1007/s001670100232 PubMedCrossRefGoogle Scholar
  18. 18.
    McAllister DR, Parker RD, Cooper AE et al (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27:562–570PubMedGoogle Scholar
  19. 19.
    Mei-Dan O, Mann G, Steinbacher G et al (2008) Septic arthritis with Staphylococcus lugdunensis following arthroscopic ACL revision with BPTB allograft. Knee Surg Sports Traumatol Arthrosc 16:15–18. doi: 10.1007/s00167-007-0379-8 PubMedCrossRefGoogle Scholar
  20. 20.
    Molina ME, Nonweiller DE, Evans JA et al (2000) Contaminated anterior cruciate ligament grafts: the efficacy of 3 sterilization agents. Arthroscopy 16:373–378. doi: 10.1016/S0749-8063(00)90081-1 PubMedCrossRefGoogle Scholar
  21. 21.
    Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am 34:49–64. doi: 10.1016/S0030-5898(02)00070-6 PubMedCrossRefGoogle Scholar
  22. 22.
    Parvizi J, Ghanem E, Sharkey P et al (2008) Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res 466:2628–2633. doi: 10.1007/s11999-008-0471-5 PubMedCrossRefGoogle Scholar
  23. 23.
    Schollin-Borg M, Michaëlsson K, Rahme H (2003) Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 19:941–947. doi: 10.1016/j.arthro.2003.09.004 PubMedCrossRefGoogle Scholar
  24. 24.
    Tuman J, Diduch DR, Baumfeld JA et al (2008) Joint infection unique to hamstring tendon harvester used during anterior cruciate ligament reconstruction surgery. Arthroscopy 24:618–620. doi: 10.1016/j.arthro.2006.12.033 PubMedCrossRefGoogle Scholar
  25. 25.
    Veen MR, Bloem RM, Petit PL (1994) Sensitivity and negative predictive value of swab cultures in musculoskeletal allograft procurement. Clin Orthop Relat Res 300:259–263PubMedGoogle Scholar
  26. 26.
    Viola R, Marzano N, Vianello R (2000) An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy 16:173–177. doi: 10.1016/S0749-8063(00)90032-X PubMedCrossRefGoogle Scholar
  27. 27.
    Williams RJIII, Laurencin CT, Warren RF et al (1997) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 25:261–267. doi: 10.1177/036354659702500222 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Iosif Gavriilidis
    • 1
  • Emilios E. Pakos
    • 1
    • 2
    Email author
  • Benjamin Wipfler
    • 1
  • Ioannis S. Benetos
    • 1
  • Hans H. Paessler
    • 1
  1. 1.ATOS ClinicCenter for Foot and Knee Surgery, Sport SurgeryHeidelbergGermany
  2. 2.NeohoropouloIoanninaGreece

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