No association between positive intraoperative allograft cultures and infection rates after reconstructive knee ligament surgery

Schmidt-Hebbel, Andrés; Gómez, Carlos Jaime Geroy; Avilés, Carolina; Herbst, Elmar; Scheu, Maximiliano; Ferrer, Gonzalo; Espinoza, Gonzalo

doi:10.1016/j.knee.2018.08.012

Cited by 3 publications

(8 citation statements)

References 24 publications

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“…as the single pathogen isolated in culture. 15 According to the CDC, until 2002, only 26 cases of bacterial infections following allograft procedures were reported in the United States, half of them caused by Clostridium spp. 20 After donor death, these microorganisms can cross the intestinal barrier and lodge in other tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have evaluated the postoperative infections after allograft implantation in knee reconstructive ligament surgeries. 13,15,26,32,33 Considering the aseptically processed grafts, rates of infection ranging from zero to 5% were described. 13,16,[23][24][25] In accordance with this, here we reported an infection rate of 3.9%.…”

Section: Discussionmentioning

confidence: 99%

“…is the only pathogen isolated (unless other microbiologic evidence of allograft contamination is present). 15 An inconsistent and limited data assessing the actual prevalence of infection after allograft implantation in different types of knee reconstructive procedures are available. 13,16 Therefore, the aim of this study was to evaluate the characteristics of postoperative infections after knee ligament reconstructions using aseptically processed allografts, and also provide an overview of the use of allografts in an academic tertiary hospital.…”

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confidence: 99%

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Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions

et al. 2021

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Postoperative infections after allograft implantation is a major concern in knee ligament reconstructions considering the theoretical risk of disease transmission and its potential severity. Here, we aimed to evaluate the postoperative infection rate after knee ligament reconstructions using aseptically processed allografts, and provide an overview of the allografts use in an academic tertiary hospital. A retrospective study was performed evaluating patients who underwent knee ligament reconstructions using aseptically processed allografts, including primary and revision surgeries, from 2005 to 2018. Demographic data, including the type of knee injury and trauma energy, and postoperative data were collected focusing on postoperative infections. Regarding these infected cases, further analyses were performed considering the presenting signs and symptoms, the isolated microorganism identified in culture, the time between graft implantation and diagnosis of infection (defined as acute, subacute, and late), and the need for graft removal. A total of 180 cases of ligament reconstructions were included. The mean follow-up was 8.2 (range: 2.1–15.6) years and the mean age at surgery was 34.1 (± 11.1) years. A total of 262 allografts were implanted in those 180 cases, 93 (35.5%) as bone plug allografts and 169 (64.5%) as soft tissue allografts. Common surgical indications included multiligament reconstruction (57.2%) and primary anterior cruciate ligament (ACL) reconstruction (15%). Seven cases (3.9%) presented postoperative infections. Knee pain (100%) and swelling (100%) were the most prevalent symptoms. Two cases (28.6%) presented sinus tract. Allografts were removed in two cases, the same cases that presented draining sinus (p = 0.04). High-energy trauma was the only statistically associated factor for infection (p = 0.04). No significant association between infection and the type of allograft (p > 0.99) or sex (p = 0.35) were observed. Four cases (57.1%) had monomicrobial staphylococcal infections. Based on that, the allograft-related infection rate was 1.7% (the remaining three infected cases). Nonirradiated, aseptically processed allografts have a low postoperative infection rate in knee ligament reconstructions, being a safe alternative for surgeries that require additional source, increased variety, and quantity of grafts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions

et al. 2021

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“…Despite the current cadaveric donor screening and tissue processing methods, allografts have the theoretical risk of disease transmission, with reported cases of HIV, Hepatitis B and C infections (likely due to window periods or human error), and Clostridium septic arthritis after their use (27)(28)(29). In addition, delayed incorporation, limited availability, and increased costs are also considerable disadvantages for allografts (21,23,27,29). Open procedures with surgical dislocation of the hip have been demonstrated to present with increased incidence of reoperations (25) and slower recovery and return to sports (26).…”

Section: Discussionmentioning

confidence: 99%

“…Arthroscopic procedures result in superior outcomes, lower reoperation rates (25), and expedited recovery compared to surgical dislocation of the hip (26). Despite inherent advantages of allografts, such as decreased surgical time and avoidance of donor-site morbidity, some disadvantages should be taken into account such as potential disease transmission, delayed incorporation, increased costs and patient refusal, making autografts the preferred source for a subset of surgeons (10,23,(27)(28)(29). Allografts may also be less readily available, or nonexistent options for surgeons in certain parts of the world.…”

Section: Introductionmentioning

confidence: 99%

Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review

Bessa¹,

Williams

Polce

et al. 2020

Front. Surg.

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Background: The acetabular labrum plays a major role in hip function and stability. The gold standard treatment for labral tears is labral repair, but in cases where tissue is not amenable to repair, reconstruction has been demonstrated to provide superior outcomes compared to debridement. Many types of grafts have been used for reconstruction with good to excellent outcomes. Autograft options include iliotibial band (ITB), semitendinosus, and indirect head of the rectus femoris tendon, while allografts have included fascia lata and gracilis tendon allografts. Questions/Purposes: As allografts are not always readily available and have some inherent disadvantages, the aims of this systematic review were to assess (1) indications for labral reconstruction and (2) summarize outcomes, complications, and reoperation rates after arthroscopic labral reconstruction with autografts. Methods: A systematic review of the literature was performed using six databases (PubMed, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar) to identify studies reporting outcomes for arthroscopic labral reconstruction utilizing autografts, with a minimum follow-up of 1 year. Study design, patient demographics, autograft choice, complications, donor site morbidity, reoperation rates, conversion to arthroplasty, and patient reported outcomes were extracted and reported. Results: Seven studies were identified for inclusion with a total of 402 patients (173 females, age range 16-72, follow-up range 12-120 months). The most commonly reported functional outcome score was the modified Harris Hip Score (mHHS), which was reported in six of seven studies. Preoperative mHHS ranged from 56 to 67.3 and improved postoperatively to a range of 81.4-97.8. Conversion to total hip arthroplasty and reoperation rates ranged from 0 to 13.2% and 0 to 11%, respectively. The most common indication for labral reconstruction was an irreparable labrum. Autografts utilized included ITB, hamstring tendons, indirect head of rectus femoris, and capsular tissue. Bessa et al. Arthroscopic Autograft Labral Reconstruction Conclusions: Arthroscopic autograft reconstruction of the acetabular labrum results in significant improvement in the short-and mid-term patient reported outcomes, for properly selected patients presenting with pain and functional limitation in the hip due to an irreparable labral injury.

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Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction

Gursoy,

Bessa,

Dandu

et al. 2024

Am J Sports Med

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Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o’clock labral position (14.1 ± 2.8 mm), and 3-o’clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P > .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest.

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No association between positive intraoperative allograft cultures and infection rates after reconstructive knee ligament surgery

Cited by 3 publications

References 24 publications

Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions

Aseptically Processed Allograft Implantation: A Safe Strategy for Knee Ligament Reconstructions

Indications and Outcomes for Arthroscopic Hip Labral Reconstruction With Autografts: A Systematic Review

Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction

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