Positive culture in allograft ACL-reconstruction: what to do?

Abstract

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment -other than an antibiotic protocol -would be required when facing a case of positive culture of a graft piece after its implantation.

Incidence of Positive Intraoperative Allograft Cultures Used in Knee Ligament Reconstruction

“…The culture-positive organisms in our study are similar to the organisms in the studies by Deijkers et al 7 and Diaz-de-Rada et al, 8 which may suggest contamination during procurement or processing. In our study, the cultures became positive 4 to 5 days postoperatively, at which point patients were not receiving antibiotics.…”

“…Of note, there was a low virulence bacterial contamination rate of 50% and a high virulence rate of 3%. Diaz-de-Rada et al 8 reported a 13% culture-positive rate in BPTB allografts used in ACL reconstructions and recommended the use of prophylactic antibiotics for 2 weeks. The study reported no clinical infections in their series, despite the high rate of positive cultures.…”

“…The study reported no clinical infections in their series, despite the high rate of positive cultures. 8 However, there is no consensus in the literature regarding the culture-positive rate, use of cultures, and clinical significance of the culture results. For this reason, we report the intraoperative culture results on this series of patients undergoing knee ligament reconstruction, as evidence of the need to culture allografts.…”

Infections in Anterior Cruciate Ligament Reconstruction

“…Likewise, Diaz-de-Rada et al had 24 positive cultures from 181 allograft implantations analyzed; no patients showed clinical infection during follow-up. 22 Hence, culture-positive evidence of allograft contamination did not correlate with infectious complications. 14 …”

Allograft Versus Autograft in Posterior Cruciate Ligament Reconstruction: An Evidence-Based Systematic Review

“…Studies that met the inclusion criteria included (1) prospective randomized controlled trials, (2) prospective and retrospective nonrandomized trials, and (3) case series.…”