Joint Infection Unique to Hamstring Tendon Harvester Used During Anterior Cruciate Ligament Reconstruction Surgery

Tuman, Jeffrey M.; Diduch, David R.; Baumfeld, Joshua A.; Rubino, L. Joseph; Hart, Joseph M.

doi:10.1016/j.arthro.2006.12.033

Cited by 15 publications

(14 citation statements)

References 4 publications

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“…Clusters of joint infections are reported among subjects who underwent ACL reconstruction (1.6–2.6%), with slight predominance with HS use (5.7%) and an increase of risk, probably due to former ACL reconstruction [relative risk (RR) = 5.1] or knee surgery (RR = 1.90) and to the use of some fixation systems for femur (RR = 4.5 for Endobutton) or tibial (RR = 3.2 with metallic post and washers) fractures [29, 30]. The infection rate, in the absence of clusters, results <1%, showing no differences in relation to the technique chosen [31].…”

Section: Resultsmentioning

confidence: 99%

Graft selection in arthroscopic anterior cruciate ligament reconstruction

Romanini

D’Angelo

Masi

et al. 2010

J Orthopaed Traumatol

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BackgroundAnterior cruciate ligament (ACL) surgical reconstruction is performed with the use of an autogenic, allogenic or synthetic graft. The document issued by the Italian National Guidelines System (SNLG, Sistema Nazionale Linee Guida) at the National Institute of Health aims to guide orthopaedic surgeons in selecting the optimal graft for ACL reconstruction using an evidence-based approach.Materials and methodsA monodisciplinary panel was formed to define a restricted number of clinical questions, develop specific search strategies and critically appraise the literature using the grading of recommendations assessment, development, and evaluation (GRADE) method. The final draft was shared by the panel and then sent to four external referees to assess its readability and clarity, its clinical relevance and the feasibility of recommendations.ResultsAutograft shows moderate superiority compared with allograft, in relation to the relevant outcomes and the quality of selected evidence, after an appropriate risk–benefit assessment. Allograft shows higher failure rate and higher risk of infection. The panel recommends use of autografts; patellar tendon should be the first choice, due to its higher stability, while use of hamstring is indicated for subjects for whom knee pain can represent a particular problem (e.g., some categories of workers).ConclusionsAutograft shows better performance compared with allograft and no significant heterogeneity in relation to relevant outcomes. The GRADE method allowed collation of all the information needed to draw up the recommendations, and to highlight the core points for discussion.

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Section: Resultsmentioning

confidence: 99%

Graft selection in arthroscopic anterior cruciate ligament reconstruction

Romanini

D’Angelo

Masi

et al. 2010

J Orthopaed Traumatol

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“…Finally, there has been a case report of 3 hamstring autograft infections attributed to improper sterilization of the graft harvester. 36 An important limitation of our study is its retrospective design. Operative details such as concurrent procedures (eg, meniscus or posterior cruciate ligament repair), tourniquet use, length of surgery, and prophylactic antibiotics were not always available in the medical records.…”

Section: Discussionmentioning

confidence: 98%

“…Furthermore, the patellar fossa may be more difficult to disinfect adequately during surgery compared with the patellar region given its more complex topography and the increased difficulty of adequately positioning patients to access this site compared with the anterior patellar. Finally, there has been a case report of 3 hamstring autograft infections attributed to improper sterilization of the graft harvester 36 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Murphy¹,

Du²,

Hua³

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine the effect of graft choice (allograft, bone-patellar tendon-bone autograft, or hamstring autograft) on deep tissue infections following anterior cruciate ligament (ACL) reconstructions. DESIGN Retrospective cohort study. SETTING AND POPULATION Patients from 6 US health plans who underwent ACL reconstruction from January 1, 2000, through December 31, 2008. METHODS We identified ACL reconstructions and potential postoperative infections using claims data. A hierarchical stratified sampling strategy was used to identify patients for medical record review to confirm ACL reconstructions and to determine allograft vs autograft tissue implanted, clinical characteristics, and infection status. We estimated infection rates overall and by graft type. We used logistic regression to assess the association between infections and patients' demographic characteristics, comorbidities, and choice of graft. RESULTS On review of 1,452 medical records, we found 55 deep wound infections. With correction for sampling weights, infection rates varied by graft type: 0.5% (95% CI, 0.3%-0.8%) with allografts, 0.6% (0.1%-1.5%) with bone-patellar tendon-bone autografts, and 2.5% (1.9%-3.1%) with hamstring autograft. After adjusting for potential confounders, we found an increased infection risk with hamstring autografts compared with allografts (odds ratio, 5.9; 95% CI, 2.8-12.8). However, there was no difference in infection risk among bone-patellar tendon-bone autografts vs allografts (odds ratio, 1.2; 95% CI, 0.3-4.8). CONCLUSIONS The overall risk for deep wound infections following ACL reconstruction is low but it does vary by graft type. Infection risk was highest in hamstring autograft recipients compared with allograft recipients and bone-patellar tendon-bone autograft recipients. Infect Control Hosp Epidemiol 2016;37:827-833.

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“…3,4,13,44,45,53,54,56,65,67 Individual reports have implicated methods of sterilization of instrumentation and hardware used for graft fixation. 38,62,66 Wang et al noted that flash sterilization of instrumentation was correlated with high rates of infection. 66 Tuman et al suggested that failure to disassemble a “tube-within-a-tube” hamstring harvester may lead to unsatisfactory sterilization, providing a potential source for contamination.…”

Section: Risk Factors For Infectionmentioning

confidence: 99%

Infections in Anterior Cruciate Ligament Reconstruction

et al. 2013

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Context:Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome.Evidence Acquisition:Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters.Results:Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates.Conclusion:The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis.

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Joint Infection Unique to Hamstring Tendon Harvester Used During Anterior Cruciate Ligament Reconstruction Surgery

Cited by 15 publications

References 4 publications

Graft selection in arthroscopic anterior cruciate ligament reconstruction

Graft selection in arthroscopic anterior cruciate ligament reconstruction

Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Infections in Anterior Cruciate Ligament Reconstruction

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