Risk Factors for Surgical Site Infections Following Anterior Cruciate Ligament Reconstruction

Abstract

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.

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

“…Several previous studies have consistently reported that the infection formation after ACL reconstruction surgery is more frequently observed in patients using hamstring autograft. [2,3,14] To prevent postoperative infection in ACL reconstruction surgery using hamstring autograft, researchers have suggested several approaches. For example, antibiotic prophylaxis or limitedly shaving the surgical area (only the required region for the surgical procedure) has been suggested in order to prevent orthopedic infections.…”

Clinical efficacy of multiple prevention measures against infection following anterior cruciate ligament reconstruction

“…It has been proven that strict sterilization of the surgical area, the use of waterproof sterile drapes, high pressure steam sterilization of the surgical instruments, and a decrease in doctors and intraoperative personnel reduce the amount of bacteria in the air. In addition, reducing the continuous operation frequency and scheduling daytime surgery could effectively reduce the risk of infection [21] . Moreover, the aseptic surgical films containing iodine used during our operation also contributed to reducing skin exposure and diminishing the movement of the bacteria that likely exist in the folliculus pili.…”

Results of anterior cruciate ligament restoration using «all inside» techniques

“…Процесс был купирован путем реви-зионной артроскопии с частичной синовэктомией, сохранением имплантатов и курсом антибактериальной терапии. Удельный вес инфекционных осложнений после пластики ПКС, по данным разных авторов, колеблется в пределах 0,2-0,6 % [4,25].…”