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Lower incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction with quadriceps tendon compared to hamstring tendons

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine and compare the incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with autologous quadriceps tendon (with patellar bone block) compared to autologous hamstring tendons (semitendinosus and gracilis).

Methods

A total of 1638 isolated R-ACLR with either autologous hamstring tendons (n = 1004, 61.3%) or quadriceps tendon (n = 634; 38.7%) were performed between 2004 and 2017 and were retrospectively analysed with regard to the occurrence of post-operative septic arthritis. The technique of R-ACLR did not significantly change during the years of the study. All patients received pre-op i.v.antibiotics, but no presoaking of the grafts in vancomycin was performed in the years of the study. The individual decision of graft choice was based on graft availability, tunnel position and the presence of tunnel widening. Generally, hamstring tendons were preferred. There were no clinically relevant differences between the groups regarding gender or age. Routine follow-up examination was performed 6 weeks after the index operation (follow-up rate 96.5%), and patients unsuspicious for septic arthritis at that time were classified as non-infected.

Results

Fourteen patients with septic arthritis were identified, resulting in an overall incidence of 0.85%. There was one patient with septic arthritis in the quadriceps tendon group (incidence: 0.16%) and 13 patients in the hamstring tendons group (incidence: 1.29%), respectively. The difference was significant (p = 0.013).

Conclusion

In this series, the incidence of post-operative septic arthritis after R-ACLR was lower when quadriceps tendon graft was used compared to hamstring tendon grafts.

Level of evidence

III.

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Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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Authors and Affiliations

  1. Centre of Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany

    Philipp Schuster, Michael Schlumberger, Philipp Mayer, Damian Oremek, Martin Eichinger & Jörg Richter

  2. Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Nuremberg, Germany

    Philipp Schuster

  3. Department of Trauma Surgery, University Hospital Innsbruck, Innsbruck, Austria

    Michael Schlumberger & Martin Eichinger

  4. Department of Orthopedic Surgery, Faculty of Medicine, University of Thessalia, Larissa, Greece

    Vasileios A. Raoulis

  5. Anatomy Laboratory, Faculty of Medicine, University of Thessalia, Larissa, Greece

    Vasileios A. Raoulis

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Correspondence to Philipp Schuster.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the competent Ethical committee.

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Investigation performed at the Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Germany.

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Schuster, P., Schlumberger, M., Mayer, P. et al. Lower incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction with quadriceps tendon compared to hamstring tendons. Knee Surg Sports Traumatol Arthrosc 28, 2572–2577 (2020). https://doi.org/10.1007/s00167-020-05878-w

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