Effect of Graft Selection on the Incidence of Postoperative Infection in Anterior Cruciate Ligament Reconstruction

Barker, Joseph U.; Drakos, Mark C.; Maak, Travis G.; Warren, Russell F.; Williams, Riley J.; Allen, Answorth A.

doi:10.1177/0363546509346414

Cited by 138 publications

(193 citation statements)

References 26 publications

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“…The present study is the first, to our knowledge, to establish diabetes as a risk factor for infection after ACL reconstruction, while the influence of graft choice is consistent with findings in previous studies 1,4 . Patient age and BMI did not influence the risk of postoperative infection after ACL reconstruction in this cohort, and there was insufficient evidence to establish an association between smoking and infection.…”

Section: Discussionsupporting

confidence: 92%

“…Maletis et al 4 reported an overall rate of infection of 0.48% after 10,626 ACL reconstructions, while Barker et al 1 reported a rate of 0.58% in 3126 patients. Judd et al 3 reported a rate of 0.68% in 1615 ACL reconstructions compared with an overall rate of 0.75% in 801 ACL reconstructions reported by Katz et al 20 .…”

Section: Discussionmentioning

confidence: 99%

“…nfection is a relatively rare but potentially serious complication after anterior cruciate ligament (ACL) reconstruction [1][2][3][4] . Because of the low prevalence of infection after ACL reconstruction, a study of such infections requires a large cohort in order to control for heterogeneous factors and to facilitate meaningful analysis of associated risk factors.…”

mentioning

confidence: 99%

“…Because of the low prevalence of infection after ACL reconstruction, a study of such infections requires a large cohort in order to control for heterogeneous factors and to facilitate meaningful analysis of associated risk factors. Recent studies on infection after ACL reconstruction have demonstrated that graft choice may be a risk factor 1,4 . Smoking has been shown to be a risk factor for infection after orthopaedic surgery 5,6 , and obesity increases the risk of infection after spinal surgery 7,8 and arthroplasty 9,10 .…”

mentioning

confidence: 99%

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Factors Associated with Infection Following Anterior Cruciate Ligament Reconstruction

Brophy¹,

Wright

Huston

et al. 2015

The Journal of Bone and Joint Surgery

110

164

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Factors Associated with Infection Following Anterior Cruciate Ligament Reconstruction

Brophy¹,

Wright

Huston

et al. 2015

The Journal of Bone and Joint Surgery

110

164

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“…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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The effects of multiple freeze–thaw cycles on the biomechanical properties of the human bone‐patellar tendon‐bone allograft

Jung

Vangipuram

Fisher

et al. 2011

Journal Orthopaedic Research

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Introduction: Soft tissue allografts, such as the bone-patellar tendon-bone (BPTB) graft, have been frequently used for anterior cruciate ligament (ACL) reconstruction. As allografts are subjected to freezing and thawing for multiple cycles, the objective of this study was to measure the changes of the biomechanical properties of the human BPTB allograft after 4 and 8 freeze–thaw cycles in comparison to a single freeze–thaw cycle. Methods: Three BPTB specimens were procured from 21 human donors and divided into three groups: 1, 4, or 8 freeze–thaw cycles. Each freeze–thaw cycle consisted of freezing at −20 ± 10°C for more than 6 h and thawing at 22 ± 3°C for at least 6 h. Tensile testing of the BPTB specimens consisted of loading between 50 N and 250 N for 100 cycles and then loading to failure. Results: Cyclic loading revealed a similar amount of creep (∼0.5 mm) among the three freeze–thaw cycles groups (p = 0.38). The stiffness of the BPTB graft for the 1, 4, and 8 freeze–thaw cycle groups were 244 ± 42 N/mm, 235 ± 39 N/mm, and 231 ± 40 N/mm, respectively (p = 0.43). Similar findings were obtained for the ultimate load of the BPTB graft (p = 0.14) and the tangent modulus of the PT substance (p = 0.41). Discussion: The results of this study suggest that there would be little measurable effect on the structural properties of the BPTB graft or mechanical properties of the PT tissue substance following 8 freeze–thaw cycles. These BPTB allografts could potentially be re-frozen without a loss in their biomechanical properties, given appropriate storage and care. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29: 1193–1198, 2011

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Effect of Graft Selection on the Incidence of Postoperative Infection in Anterior Cruciate Ligament Reconstruction

Abstract: Hamstring tendon autografts have a higher incidence of infection than BPTB autografts or allografts. The use of allograft material in ACL reconstructions does not increase the risk of infection or the need for graft removal with infection.

Cited by 138 publications

References 26 publications

Factors Associated with Infection Following Anterior Cruciate Ligament Reconstruction

Factors Associated with Infection Following Anterior Cruciate Ligament Reconstruction

The In Vitro Elution Characteristics of Vancomycin from Tendons

The effects of multiple freeze–thaw cycles on the biomechanical properties of the human bone‐patellar tendon‐bone allograft

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