Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques^[*]

Abstract

Objective

To evaluate the contamination rate of hamstring tendon autografts by comparing two different techniques, and to verify whether intraoperative contamination is associated with the development of clinical infection in patients submitted to reconstruction of the anterior cruciate ligament (ACL).

Methods

A total of 110 hamstring tendon autograft ACL reconstructions were performed and divided into two groups: 1–hamstring tendon retraction technique; and 2 - technique maintaining the tibial insertion of the hamstring tendon. During the preparation, two graft fragments were sent for culturing; the harvesting time, the preparation time, and the total surgery time were measured. Twenty-four hours after the surgery, the C-reactive protein was assayed. The clinical outpatient follow-up was performed up to 180 days postoperatively.

Results

Although there were two postoperative infections, there was no graft contamination or difference between the groups in relation to the graft preparation time and to the 24-hour postoperative C-reactive protein assessment. The classic technique presented a longer graft harvesting time (p = 0.038), and there was no statistical difference between the 2 groups regarding the degree of contamination and consequent clinical infection, although 2 patients in group 2 presented with infection, with negative perioperative cultures.

Conclusion

Based on the results obtained, there was no association between graft contamination and the time or technique of its preparation. In addition, there was also no association between intraoperative contamination and the development of clinical infection, nor was there any sign of an association between the early alteration of C-reactive protein and the onset of infection.

Keywords

flexor graft - anterior cruciate ligament reconstruction - infection - septic arthritis

^* Work developed at the Hospital Madre Teresa, Belo Horizonte, MG, Brazil.

• Referências

• 1 Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graft-retaining treatment protocol. Am J Sports Med 2015; 43 (12) 3005-12
• 2 Leathers MP, Merz A, Wong J, Scott T, Wang JC, Hame SL. Trends and demographics in anterior cruciate ligament reconstruction in the United States. J Knee Surg 2015; 28 (05) 390-4
• 3 Benner RW, Shelbourne KD, Freeman H. Infections and patellar tendon ruptures after anterior cruciate ligament reconstruction: a comparison of ipsilateral and contralateral patellar tendon autografts. Am J Sports Med 2011; 39 (03) 519-25
• 4 Katz LM, Battaglia TC, Patino P, Reichmann W, Hunter DJ, Richmond JC. A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy 2008; 24 (12) 1330-5
• 5 Torres-Claramunt R, Pelfort X, Erquicia J, Gil-González S, Gelber PE, Puig L. , et al. Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc 2013; 21 (12) 2844-49
• 6 Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 2009; 25 (03) 243-9
• 7 Williams III RJ, Laurencin CT, Warren RF, Speciale AC, Brause BD, O'Brien S. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management. Am J Sports Med 1997; 25 (02) 261-7
• 8 Frank M, Schmucker U, David S, Matthes G, Ekkernkamp A, Seifert J. Devastating femoral osteomyelitis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008; 16 (01) 71-4
• 9 Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H. Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 2007; 35 (07) 1059-63
• 10 Mouzopoulos G, Fotopoulos VC, Tzurbakis M. Septic knee arthritis following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1033-42
• 11 Hantes ME, Basdekis GK, Varitimidis SE, Giotikas D, Petinaki E, Malizos KN. Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2008; 90 (04) 760-4
• 12 Christel P. Graft choice in ACL reconstruction: which one and why?. In: Sanchis-Alfonso V, Monllau JC. , eds. The ACL-deficient knee. A problem solving approach. London: Springer Verlag; 2013: 105-12
• 13 Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 2004; 86 (10) 2143-55
• 14 Pandarinath R, Ciccotti M, DeLuca PF. Current trends in ACL reconstruction among professional team physicians. In: Proceedings of the AAOS 2011 Annual Meeting, 2011 , paper 324
• 15 Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 2007; 35 (04) 564-74
• 16 Kim SJ, Kim HK, Lee YT. Arthroscopic anterior cruciate ligament reconstruction using autogenous hamstring tendon graft without detachment of the tibial insertion. Arthroscopy 1997; 13 (05) 656-60
• 17 Gupta R, Bahadur R, Malhotra A, Masih GD, Gupta P. Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions. Arthrosc Tech 2016; 5 (02) e269-e74
• 18 Deie M, Ochi M, Ikuta Y. High intrinsic healing potential of human anterior cruciate ligament. Organ culture experiments. Acta Orthop Scand 1995; 66 (01) 28-32
• 19 Sonnery-Cottet B, Lavoie F, Ogassawara R, Scussiato RG, Kidder JF, Chambat P. Selective anteromedial bundle reconstruction in partial ACL tears: a series of 36 patients with mean 24 months follow-up. Knee Surg Sports Traumatol Arthrosc 2010; 18 (01) 47-51
• 20 Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M. , et al. Anterolateral Ligament Reconstruction Is Associated with Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients from the SANTI Study Group. Am J Sports Med 2017; 45 (07) 1547-57
• 21 Nakayama H, Yagi M, Yoshiya S, Takesue Y. Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2012; 28 (05) 667-71
• 22 Badran MA, Moemen DM. Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study. Int Orthop 2016; 40 (09) 1899-903
• 23 Gavriilidis I, Pakos EE, Wipfler B, Benetos IS, Paessler HH. Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009; 17 (09) 1043-7
• 24 Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21 (03) 696-701
• 25 Barbier O, Danis J, Versier G, Ollat D. When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy. Knee 2015; 22 (05) 380-3
• 26 Paocharoen V, Mingmalairak C, Apisarnthanarak A. Comparison of surgical wound infection after preoperative skin preparation with 4% chlorhexidine [correction of chlohexidine] and povidone iodine: a prospective randomized trial. J Med Assoc Thai 2009; 92 (07) 898-902
• 27 Lee I, Agarwal RK, Lee BY, Fishman NO, Umscheid CA. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol 2010; 31 (12) 1219-29
• 28 Noorani A, Rabey N, Walsh SR, Davies RJ. Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. Br J Surg 2010; 97 (11) 1614-20
• 29 Izquierdo Jr R, Cadet ER, Bauer R, Stanwood W, Levine WN, Ahmad CS. A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts. Arthroscopy 2005; 21 (11) 1348-53
• 30 Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (04) 375-84