1
|
Nagira K, Enokida M, Hayashi I, Ishida K, Kanaya H, Nagashima H. A Simple Method to Reduce the Incidence of Cyclops Lesion after Anterior Cruciate Ligament Reconstruction. J Knee Surg 2021; 34:546-551. [PMID: 31561256 DOI: 10.1055/s-0039-1697625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study is to determine the influence of debridement in and around the bone tunnels on the prevalence of cyclops lesion (CL), after anterior cruciate ligament reconstruction (ACLR) with hamstring grafts. Our hypothesis was that bone tunnel debridement during ACLR would reduce the prevalence of CL. Methods for debridement in and around the bone tunnels after tunnel drilling were standardized and applied to 38 knees undergoing double-bundle ACLR between 2011 and 2014, Group A (debridement group). Group B (nondebridement group) included 56 knees in which bone tunnel debridement was not performed. Postoperative MRI was performed to evaluate the presence of CL and the following three criteria: (1) the intercondylar site of CL (grade 1-3), depending on its anterior extent along the femoral condyle; (2) posterior bowing of the ACL graft; and (3) the positional relationship between the frontmost fiber of ACL graft and Blumensaat's line. If CL caused loss of extension or pain or discomfort during knee extension, it was defined as symptomatic CL (SCL). CL was detected in 8 cases (21.1%) in Group A and 26 cases (46.4%) in Group B. The prevalence of CL was significantly lower in Group A than in Group B (p = 0.010), and the risk ratio of CL was 0.31 (95% confidence interval: 0.12-0.79). Furthermore, 10 patients in Group B had SCL, compared with none in Group A (p = 0.004). In Group A, the intercondylar site of CL was grade 1 in all cases, while in Group B, the CL grades were 1 (n = 17), 2 (n = 7), 3 (n = 2) (p = 0.008). There were no cases of posterior bowing of the ACL in Group A, but six cases in Group B (p = 0.023). Debridement in and around the bone tunnel is a simple and effective method of preventing CL and SCL after ACLR. The level of evidence for the study is 3.
Collapse
Affiliation(s)
- Keita Nagira
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Makoto Enokida
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Ikuta Hayashi
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Koji Ishida
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Haruhisa Kanaya
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Tottori University, Yonago, Tottori, Japan
| |
Collapse
|
2
|
Korkerdsup T, Ngarmukos T, Sungkanuparph S, Phuphuakrat A. Cardiac implantable electronic device infection in the cardiac referral center in Thailand: incidence, microbiology, risk factors, and outcomes. J Arrhythm 2018; 34:632-639. [PMID: 30555607 PMCID: PMC6288561 DOI: 10.1002/joa3.12123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/26/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite the long experience of cardiac implantable electronic device (CIED) implantation in Thailand, epidemiology of CIED infection in Thailand has never been studied. METHODS A retrospective cohort study was conducted at the cardiac referral center in Thailand to investigate incidence of CIED infection and causative organisms between October 2002 and December 2017. A matched case-control study was performed to determine the factors associated with CIED infection. RESULTS Incidence of CIED infection was 0.9% with a stable trend during the studied period. There were 54 episodes of CIED infection. The median (interquartile range) age of the patients was 67.5 (53.0-75.0) years. A total of 29 (53.7%), 18 (33.3%), and 7 (13.0%) were permanent pacemaker, automatic implantable cardioverter-defibrillator, and cardio-resynchronization therapy-related infection, respectively. Gram-positive cocci were the most common organism (24 episodes, 44.4%). Gram-negative bacilli were isolated in six episodes (11.1%). About 9.3% were polymicrobial and 35.2% were culture negative. Multivariate analysis showed that previous CIED infection and generator revision procedure were associated with CIED infection (odds ratio [OR] 48.56, 95% confidence interval [CI] 3.72-633.62; P = 0.003 and OR 19.99, 95% CI 1.28-333.24; P = 0.033 respectively). Forty (74.1%) cases were cured. Leaving device in situ was the only factor significantly associated with poor outcome (OR 11.40, 95% CI 1.52-85.73; P = 0.018). CONCLUSIONS In Thailand, while CIED implantation is rising, incidence of CIED infection is stable. Microbiology of CIED infection in Thailand is similar to western countries, albeit a higher proportion of negative culture. Previous CIED infection and generator revision procedure are associated with CIED infection.
Collapse
Affiliation(s)
- Theerawat Korkerdsup
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Tachapong Ngarmukos
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Somnuek Sungkanuparph
- Chakri Naruebodindra Medical InstituteFaculty of Medicine Ramathibodi HospitalMahidol UniversitySamut PrakanThailand
| | - Angsana Phuphuakrat
- Department of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| |
Collapse
|
3
|
Sinha SK, Sivasambu B, Yenokyan G, Crawford TC, Chrispin J, Eagle KA, Barth AS, Rickard JJ, Spragg DD, Vlay SC, Berger R, Love C, Calkins H, Tomaselli GF, Marine JE. Worldwide pacemaker and defibrillator reuse: Systematic review and meta-analysis of contemporary trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1500-1507. [PMID: 30191580 DOI: 10.1111/pace.13488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/21/2018] [Accepted: 08/26/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients go without pacemaker, defibrillator, and cardiac resynchronization therapies (devices) each year due to the prohibitive costs of devices. OBJECTIVE We sought to examine data available from studies regarding contemporary risks of reused devices in comparison with new devices. METHODS We searched online indexing sites to identify recent studies. Peer-reviewed manuscripts reporting infection, malfunction, premature battery depletion, and device-related death with reused devices were included. The primary study outcome was the composite risk of infection, malfunction, premature battery depletion, and death. Secondary outcomes were the individual risks. RESULTS Nine observational studies (published 2009-2017) were identified totaling 2,302 devices (2,017 pacemakers, 285 defibrillators). Five controlled trials were included in meta-analysis (2,114 devices; 1,258 new vs 856 reused). All device reuse protocols employed interrogation to confirm longevity and functionality, disinfectant therapy, and, usually, additional biocidal agents, packaging, and ethylene oxide gas sterilization. Demographic characteristics, indications for pacing, and median follow-up were similar. There were no device-related deaths reported and no statistically significant difference in risk between new versus reused devices for the primary outcome (2.23% vs 3.86% respectively, P = 0.807, odds ratio = 0.76). There were no significant differences seen in the secondary outcomes for the individual risks of infection, malfunction, and premature battery depletion. CONCLUSIONS Device reuse utilizing modern protocols did not significantly increase risk of infection, malfunction, premature battery depletion, or device-related death in observational studies. These data provide rationale for proceeding with a prospective multicenter noninferiority randomized control trial.
Collapse
Affiliation(s)
- Sunil K Sinha
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhradeev Sivasambu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gayane Yenokyan
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas C Crawford
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kim A Eagle
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andreas S Barth
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John Jack Rickard
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - David D Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Vlay
- SUNY Health Sciences Center, Stony Brook University, Stony Brook, NY, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles Love
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
Ze F, Li X, Zhang P, Zhang H, Wang L, Li D, Duan J, Guo F, Yuan C, Guo J. Reuse of infected cardiac rhythm management devices in the same patients: a single-center experience. Pacing Clin Electrophysiol 2014; 37:940-6. [PMID: 24499265 DOI: 10.1111/pace.12352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 11/21/2013] [Accepted: 12/17/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND In developing countries, patients with a cardiac rhythm management device (CRMD) that has become infected cannot always afford a new device, and reuse of the infected CRMD may be appropriate. To evaluate the safety of this practice, a cohort of consecutive patients with reused pacemakers was compared with a control group. METHODS A single-center cohort of consecutive patients treated from 2007 to 2012 was analyzed in a two-way noninferiority study. Patients who had infected CRMDs removed at the Cardiovascular Center of The Peking University People's Hospital were enrolled, including those who had the same CRMD reimplanted and those who had a new CRMD implanted. RESULTS This study included 212 patients, of who 99 (study group) had the same CRMD reimplanted, and 113 (control group) had a new CRMD implanted. During a mean follow-up period of 3.52 years (interquartile range: 2.1-4.7 years), 10 patients reached the primary end point of the study (infection, unexpected battery depletion, or device malfunction), including five (5%) in the study group and five (4.3%) in the control group. Recurrent infection occurred in three patients in the study group and two patients in the control group (3.0% vs 1.7%, relative risk: 1.29, 95% confidence interval: 0.62-2.29, P = 0.561). There were no cases of unexpected battery depletion in either group. CONCLUSIONS Reuse of infected CRMDs in the same patients is noninferior to the implantation of new devices. In developing countries without full medical coverage, careful reuse of infected CRMDs can be considered.
Collapse
Affiliation(s)
- Feng Ze
- Department of Cardiac Electrophysiology, Peking University People's Hospital, Beijing, China; Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|