Can infection after anterior cruciate ligament surgery be prevented by inserting a Hemovac drain into graft donor site?

Abstract

Anterior cruciate ligament (ACL) reconstruction surgery is a highly successful orthopedic surgery providing both functional stability of the knee and more active participation of a person in daily life. [1,2] Postoperative infection following ACL reconstruction in normal population is reported to be highly rare with the incidence rate of only 0.14 to 1.4%. [2-8] On the other hand, the incidence rate among professional athletes was reported as high as 5.7%. [9] Although the occurrence of postoperative infection is very rare, once occurring, it causes devastating complications that can lead to significant problems such as cartilage destruction, arthrofibrosis, loss of range of motion and decreased activity level. [4,5,7,10,11] Although there are no pre-defined treatment guidelines for the postoperative infection, the treatment of the infection after ACL reconstruction is open or arthroscopic debridement supported by usage of antibiotic. [12,13] Preventing from infection becomes more critical because of both the difficulty of postoperative infection treatment and the high likelihood of adverse outcomes despite the extended treatment. Though previous studies have not revealed any exact cause, the frequency of infection in the use of hamstring autograft in ACL reconstruction surgery is higher than in bone patellar Objectives: This study aims to investigate the effect of Hemovac drainage placed in graft harvesting area on preventing deep surgical site infection (SSI) and/or septic arthritis through draining the hematoma formed in the graft area in arthroscopic primary anterior cruciate ligament (ACL) reconstruction surgery using hamstring autograft. Patients and methods: This retrospective study was conducted between January 2008 and March 2019. A total of 819 patients (769 males, 50 females; mean age 33.7 years; range, 25 to 41 years) who underwent arthroscopic primary ACL reconstruction surgery using hamstring autograft were divided into two groups based on whether a Hemovac drain was also placed at the hamstring graft harvested area. Both groups were compared in terms of the presence of deep SSI and/or development of septic arthritis. Results: In the non-drained group (group 1, n=401), 16 patients (3.9%) had septic arthritis, four (0.9%) had deep SSI, and two (0.49%) had both wound and joint infections. Septic arthritis was identified in only one patient (0.2%) in the drained group (group 2, n=418). In group 2, the mean amount of blood coming from the drain at the graft harvesting region was 36.85 mL (range, 20-50 mL). Conclusion: In arthroscopic primary ACL reconstruction surgery using hamstring tendon autograft, we concluded that the use of a Hemovac drain could be effective in preventing deep SSI through reducing the hematoma occurring in this region. However, future studies are needed to validate the effect of Hemovac drain on preventing the septic arthritis.

Influence of Staphylococcus epidermidis biofilm on the mechanical strength of soft tissue allograft

“… 19 Another study suggested that through reducing hematoma occurrence postsurgery using a Hemovac drain, deep surgical site infections could be reduced when using hamstring tendon allografts. 20 Given the results of our study, it is important to consider the role of ACL infection prevention given the favorable outcomes presented in several studies performed.…”

“…Some studies, including a systematic review by Xiao et al, found that soaking ACL tendon grafts with vancomycin before implantation was associated with a nearly 15 times decrease in infection compared with grafts not soaked 19 . Another study suggested that through reducing hematoma occurrence postsurgery using a Hemovac drain, deep surgical site infections could be reduced when using hamstring tendon allografts 20 . Given the results of our study, it is important to consider the role of ACL infection prevention given the favorable outcomes presented in several studies performed.…”

Is Lever Test Superior to Lachman, Pivot Shift, Drawer Tests in Diagnosing Anterior Cruciate Ligament Injuries?

“…The anterior cruciate ligament (ACL) is one of the primary ligaments of the tibio-femoral joint and has an important role in the motion and stabilization of the knee [1][2][3][4][5][6][7][8]. ACL injuries are one of the important health problems affecting the quality of life of individuals, and many reasons can lie in the etiology from injuries to wrong movements in sports activities.…”

A Novel Device for Blood Drainage after Le Fort I Osteotomy: Maxillary Sinus Ventilation Drainage (MSVD)

“…Postoperative hematoma is a suitable environment for the growth of bacteria and increases the risk of postoperative infection [5]. Drainage of the hematoma in a surgical wound is considered effective in reducing infection [6].…”