1
|
Dadoo S, Herman ZJ, Hughes JD. Surgical Techniques in Primary ACL Reconstruction: Getting It Right the First Time. Clin Sports Med 2024; 43:399-412. [PMID: 38811118 DOI: 10.1016/j.csm.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
The ideal anterior cruciate ligament reconstruction (ACLR) is an individualized anatomic approach aimed at restoring the native structure and function of the knee. Surgeons are tasked with difficult decisions during operative planning, including the optimal graft choice for the patient and appropriate anatomic tunnel placement. Special considerations should additionally be given for skeletally immature patients and those at high-risk for failure, including younger, active patients participating in pivoting sports. The purpose of this review is to provide an overview of the individualized approach to ACLR, including the necessary preoperative and operative considerations to optimize patient outcomes.
Collapse
Affiliation(s)
- Sahil Dadoo
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA.
| | - Zachary J Herman
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA
| | - Jonathan D Hughes
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water Street, Pittsburgh, PA 15203, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Schneider JG, Ormseth B, DiBartola AC, Magnussen RA, Duerr RA, Stoodley P, Flanigan DC. Incidence, Common Pathogens, and Risk Factors for Infection after Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Knee Surg 2024; 37:470-481. [PMID: 37734405 DOI: 10.1055/a-2179-3678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
We sought to assess the current literature to present a comprehensive summary of the incidence, common pathogens, and risk factors for infection after anterior cruciate ligament (ACL) reconstruction. PubMed, CINAHL, EMBASE, and Scopus databases were searched for relevant studies reporting on infection after ACL reconstruction. Two reviewers independently screened the extracted studies for adherence to inclusion and exclusion criteria. Studies were selected if they reported on the incidence of infection, pathogens cultured from infected knees, or risk factors for infection after primary ACL reconstruction. Exclusion criteria consisted of studies with fewer than 100 patients or studies that included revision ACL reconstruction. Fifty studies met the inclusion and exclusion criteria, reporting on a total of 316,214 ACL reconstructions. Included studies evaluated between 123 and 104,255 patients. The overall incidence of infection was 0.60% (0.15-2.44%). The most common pathogens were Staphylococcus aureus, S. epidermidis, and coagulase-negative Staphylococci. Five studies reported that the use of hamstring autograft was a statistically significant risk factor for infection after ACL reconstruction, thus making hamstring autograft the most commonly reported risk factor. Other reported risk factors included male sex, use of immuno-suppressive medications or intraarticular steroid injections, prior knee surgery, and diabetes. Systematic review of the literature revealed that infection after ACL reconstruction remains an infrequent event with an incidence of 0.60% (0.15-2.44%). Furthermore, the most common pathogens are from the Staphylococcus genus of bacteria, comprising 84% of all culture-positive infections. Multiple risk factors have been reported for ACL reconstruction; however, statistical significance varied across studies. Together, these findings may help guide physicians in the prevention and treatment of infection after ACL reconstruction.
Collapse
Affiliation(s)
| | | | - Alex C DiBartola
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Paul Stoodley
- Department of Microbial Infection and Immunity and the Department of Orthopaedics, The Ohio State University School of Medicine, The Ohio State University, Columbus, Ohio
| | - David C Flanigan
- Sports Medicine and the Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
3
|
Zhang L, Yang R, Mao Y, Fu W. A Systematic Review and Meta-analysis of Risk Factors for an Infection After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231200822. [PMID: 37846316 PMCID: PMC10576935 DOI: 10.1177/23259671231200822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 10/18/2023] Open
Abstract
Background Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication. Purpose To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR. Study Design Systematic review; Level of evidence, 4. Methods The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted. Results A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery. Conclusion This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication.
Collapse
Affiliation(s)
- Lei Zhang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Runze Yang
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
4
|
Paiz CC, Richter DL. Patellar Tendon Rupture 12 Years after ACL Reconstruction with BPTB Autograft. Case Rep Orthop 2023; 2023:5591956. [PMID: 37808008 PMCID: PMC10551466 DOI: 10.1155/2023/5591956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
We present a case of a 33-year-old male with a history of anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft and prior ipsilateral hamstring harvest, who presented with a complete patella tendon rupture (PTR) 12 years after ACLR. The patient underwent a successful patellar tendon (PT) repair augmented with Achilles tendon allograft and cerclage with nonabsorbable suture tape. PTR after ACLR with BPTB autograft is rare, particularly in patients over a decade out from the index procedure, but can occur. This case report highlights a novel technique for PT repair following BTB ACLR in a hamstring deficient knee.
Collapse
Affiliation(s)
- Christopher C. Paiz
- The University of New Mexico Hospital, Department of Orthopaedics, Albuquerque, New Mexico, USA
| | - Dustin L. Richter
- The University of New Mexico Hospital, Department of Orthopaedics, Albuquerque, New Mexico, USA
| |
Collapse
|
5
|
Fan D, Ma J, Zhang L. Contralateral grafts have comparable efficacy to ipsilateral grafts in anterior cruciate ligament reconstructions: a systematic review. J Orthop Surg Res 2023; 18:596. [PMID: 37568165 PMCID: PMC10422826 DOI: 10.1186/s13018-023-04082-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/06/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE To perform a systematic review of the clinical outcomes of anterior cruciate ligament reconstruction using either contralateral or ipsilateral tendon autografts. METHODS A systematic review of literature published from inception to December 9, 2022, in multiple databases (PubMed, Embase, Scopus, and the Cochrane Library) was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines. Two reviewers independently screened the literature, extracted the data, performed the risk of bias assessment and assessed the study quality. At least one of the following outcomes was evaluated for each study: muscle strength (isometric strength of the quadriceps or hamstring muscles, isokinetic peak flexion torque of the hamstring, or isokinetic peak extension torque of the hamstring), knee laxity examination, Lysholm score, pivot shift, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lachman test result, return to sports time, or incidence of complications. A random effects model was used for all analyses. RESULTS Four hundred scientific manuscripts were recovered in the initial search. After screening, 12 studies (2 randomized controlled trials, 9 cohort studies, and 1 case- control study) met the search criteria for the qualitative analysis. Among them, 9 cohort studies were used for the quantitative analysis. The results showed few statistically significant differences in terms of muscle strength (contralateral group versus ipsilateral group or donor site group versus ipsilateral group or donor site group versus nonoperative group), Lysholm score, and return to sports time. A comparison showed no significant differences in knee laxity, IKDC score, Tegner activity score, Lachman test score, or incidence of complication, or contralateral rupture. CONCLUSIONS In anterior cruciate ligament reconstruction, the contralateral autologous tendon has a similar effect as the ipsilateral autologous tendon.
Collapse
Affiliation(s)
- DingYuan Fan
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
- Beijing University of Chinese Medicine, Beijing, China
- University College London, London, UK
| | - Jia Ma
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China
| | - Lei Zhang
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China.
- Academy of Chinese Medical Sciences, No 6, South Zhonghuan Road, Chaoyang District, Beijing, 100102, People's Republic of China.
| |
Collapse
|
6
|
Trasolini NA, Lan R, Bolia IK, Hill W, Thompson AA, Mayfield CK, Knapik DM, Cole BJ, Weber AE. Knee Extensor Mechanism Complications After Autograft Harvest in ACL Reconstruction: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231177665. [PMID: 37465207 PMCID: PMC10350773 DOI: 10.1177/23259671231177665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/09/2023] [Indexed: 07/20/2023] Open
Abstract
Background Existing systematic reviews have sought to characterize the relative donor-site morbidity of bone-patellar tendon-bone (BTB) and quadriceps tendon (QT) grafts after anterior cruciate ligament reconstruction (ACLR). However, no studies have reported the pooled proportions of patellar fractures and donor tendon ruptures across the body of literature. Purpose To estimate the proportion of patellar fractures, patellar tendon ruptures, and QT ruptures associated with BTB or QT autograft harvest during ACLR using published data. Study Design Systematic review; Level of evidence, 4. Methods A meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using 3 online databases (PubMed, Scopus, and Web of Science). A total of 800 manuscripts were included in the initial research of peer-reviewed articles in English that reported extensor mechanism complications associated with graft harvest in patients after ACLR. Pooled proportions of patellar fractures, patellar tendon ruptures, and QT ruptures were calculated for each graft type (BTB, QT) using a random-effects model for meta-analysis. Results A total of 28 studies were analyzed. The pooled proportion of patellar fractures was 0.57% (95% CI, 0.34%-0.91%) for the BTB harvest and 2.03% (95% CI, 0.78%-3.89%) for the QT harvest. The proportion of patellar tendon ruptures was 0.22% (95% CI, 0.14%-0.33%) after the BTB harvest, and the proportion of QT ruptures was 0.52% (95% CI, 0.06%-1.91%) after the QT harvest. The majority of included studies (16/28 [57.1%]) had an evidence level of 4. Conclusion Based on the current literature, the proportion of extensor mechanism complications after ACLR using either a BTB or a QT autograft is low, indicating that the extensor mechanism harvest remains a safe option. A higher proportion of patellar fractures was noted for QT grafts and a higher proportion of donor tendon ruptures was noted for QT grafts compared with BTB grafts.
Collapse
Affiliation(s)
- Nicholas A. Trasolini
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - Ioanna K. Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - William Hill
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - Ashley A. Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - Cory K. Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| | - Derrick M. Knapik
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Alexander E. Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA
| |
Collapse
|
7
|
Shelbourne KD, Benner R, Gray T, Bauman S. Range of Motion, Strength, and Function After ACL Reconstruction Using a Contralateral Patellar Tendon Graft. Orthop J Sports Med 2022; 10:23259671221138103. [PMID: 36479460 PMCID: PMC9720827 DOI: 10.1177/23259671221138103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Regaining preinjury levels of activity and progressing rehabilitation factors after anterior cruciate ligament (ACL) reconstruction have shown mixed results. PURPOSE To evaluate the timing and rate of return for knee range of motion (ROM), stability, strength, and subjective scores after ACL reconstruction with contralateral patellar tendon graft (PTG). STUDY DESIGN Case series; Level of evidence, 4. METHODS Included were 2148 patients (1238 male patients, 910 female patients) who underwent primary ACL reconstruction with a contralateral PTG between 1995 and 2017 and had complete objective data through 3 months of follow-up. All patients participated in a rehabilitation program specific to goals for each knee. Patients were evaluated objectively with goniometric measurement of ROM, isokinetic quadriceps strength testing, and laxity with a KT-2000 arthrometer. Subjective data were collected at 2 and 5 years. RESULTS Normal extension on the reconstructed knee was attained for 95% of patients at 1 week postoperatively; normal flexion on the reconstructed knee was reached by 77% of patients by 3 months. At 3 months postoperatively, mean limb symmetry index strength was 104%, and the strength on the ACL-reconstructed and graft-donor knees was 87% and 86% of their respective preoperative strength. Mean manual maximum side-to-side difference in laxity was 2.0 mm at 1 month. Most patients (90%) returned to level 8 sports or higher and did so at an average of 5.7 months. Mean International Knee Documentation Committee scores for the ACL-reconstructed and graft-donor knees were 89 and 91 at 2 years (n = 1015 patients) and 84 and 90 at 5 years (n = 1275 patients), respectively. Mean Cincinnati Knee Rating Scale scores for the ACL-reconstructed and graft-donor knees were 92 and 96 at 2 years (n = 1184) and 88 and 94 at 5 years (n = 1236), respectively. CONCLUSION For patients who underwent ACL reconstruction with a contralateral PTG, postoperative ROM and strength were restored quickly by splitting the rehabilitation into different goals between the two knees. Using a contralateral PTG, this structured rehabilitation plan can lead to a relatively quick return to sport and good subjective long-term outcomes.
Collapse
Affiliation(s)
| | | | - Tinker Gray
- Shelbourne Knee Center, Indianapolis, Indiana, USA
| | - Scot Bauman
- Shelbourne Knee Center, Indianapolis, Indiana, USA
| |
Collapse
|
8
|
Sim K, Rahardja R, Zhu M, Young SW. Optimal Graft Choice in Athletic Patients with Anterior Cruciate Ligament Injuries: Review and Clinical Insights. Open Access J Sports Med 2022; 13:55-67. [PMID: 35800660 PMCID: PMC9255990 DOI: 10.2147/oajsm.s340702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/23/2022] [Indexed: 12/03/2022] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a common sporting-related knee injury with a potentially detrimental impact on the athlete’s career, yet there is no formal consensus on the optimal graft choice for reconstructing the ruptured ACL in this specific population. Options for reconstruction include autograft, allograft, and artificial grafts. However, each has associated failure risk and donor site morbidity. Our operational definition of the athlete is a skeletally mature individual participating in high level activity with the expectation to return to pre-injury level of activity. The athlete has unique injury characteristics, post-operative expectations, and graft demands that differ to the general population. Long-term outcomes are of particular importance given on-going mechanical demands on the reconstructed knee. Therefore, the purpose of this review is to consolidate current literature on the various ACL reconstruction graft options, with a focus on the optimal graft for returning the athlete to activity with the lowest rate of re-injury.
Collapse
Affiliation(s)
- Katarina Sim
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Correspondence: Katarina Sim, Department of Orthopaedics, North Shore Hospital, 124 Shakespeare Road, Takapuna, Auckland, 0620, New Zealand, Email
| | - Richard Rahardja
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark Zhu
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| |
Collapse
|
9
|
Pullen WM, Money AJ, Ray TE, Freehill MT, Sherman SL. Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon. Sports Med Arthrosc Rev 2022; 30:17-23. [PMID: 35113838 DOI: 10.1097/jsa.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.
Collapse
Affiliation(s)
- W Michael Pullen
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Adam J Money
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA
| | - Taylor E Ray
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| |
Collapse
|
10
|
[Management algorithm for septic arthritis after anterior cruciate ligament reconstruction]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34650284 PMCID: PMC8517665 DOI: 10.19723/j.issn.1671-167x.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction. METHODS A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized. RESULTS A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P<0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042). CONCLUSION Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.
Collapse
|
11
|
Sanada T, Uchiyama E, Iwaso H, Fukai A. Muscle strength after the anterior cruciate ligament reconstruction via contralateral bone-tendon-bone autograft. J Exp Orthop 2021; 8:86. [PMID: 34617148 PMCID: PMC8494824 DOI: 10.1186/s40634-021-00399-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The anterior cruciate ligament (ACL) reconstruction via a contralateral bone-tendon-bone (C-BTB) autograft was introduced to encourage early return to sports. The purpose of this study is to evaluate whether primary contralateral BTB ACL reconstruction can be adapted for early return-to-sports modification by investigating the chronological changes of muscle strength after surgery. Methods Fifteen patients who had underwent C-BTB ACL reconstruction were compared with a matched group of 15 patients of ipsilateral BTB (I-BTB) ACL reconstruction. The clinical outcomes of the time of return-to-sports, Tegner activity scale and the rate of second ACL injuries, the tibial anterior translation measurement, and knee extension and flexion muscle strength were assessed. Results Within 12 months after surgery, 14 of 15 patients from both groups returned to preinjury sports. The median time to return to sports after surgery was 6.5 months in the C-BTB group and 8.0 months in the I-BTB group (p = 0.021). No significant difference was noted with regard to the Tegner activity scale, reinjury rate or mean instrumental anterior tibial translation. The quadriceps muscle strength in the ACL-reconstructed knee compared with the opposite knee in both groups at 5 months after surgery was 120.6% in the C-BTB group and 70.0% in the I-BTB group (p < 0.001). However, the quadriceps muscle strength of the non-reconstructed limb, which instructed the graft harvested knee in the C-BTB and the intact knee in the I-BTB group, compared with that of the preoperative uninjured limb, was 74.5% in the C-BTB group and 118.7% in the I-BTB group (p = 0.0021) 5 months after surgery. Moreover, the quadriceps muscle strength of the reconstructed knee compared with the preoperative normal limb was 88.8% and 81.5% in the C-BTB and I-BTB groups, respectively (p = 0.38). Conclusions ACL reconstruction via the C-BTB autograft indicated better quadriceps muscle strength from early stage after surgery compared with I-BTB ACL reconstruction. However, the ostensible rapid symmetrical muscle strength recovery was attributed to strength deficits compared to the preoperative condition at the donor site limb and ACL-reconstructed limb. Level of evidence Level: Level: 4.
Collapse
Affiliation(s)
- Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshicho, Nakahara-Ku, Kawasaki, Kanagawa Prefecture, 211-8510, Japan.
| | | | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshicho, Nakahara-Ku, Kawasaki, Kanagawa Prefecture, 211-8510, Japan
| | - Atsushi Fukai
- Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| |
Collapse
|
12
|
Kuršumović K, Charalambous CP. Relationship of Graft Type and Vancomycin Presoaking to Rate of Infection in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2020; 8:e1900156. [DOI: 10.2106/jbjs.rvw.19.00156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
13
|
|
14
|
Haskoor JP, Busconi BD. Patellar Tendon Reconstruction Using Semitendinosus Autograft With Preserved Distal Insertion for Treatment of Patellar Tendon Rupture After Bone-Patellar Tendon-Bone ACL Reconstruction: A Case Report. Orthop J Sports Med 2019; 7:2325967119877802. [PMID: 31663009 PMCID: PMC6796198 DOI: 10.1177/2325967119877802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- John P Haskoor
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Brian D Busconi
- Department of Orthopedic Surgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| |
Collapse
|
15
|
Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques. Rev Bras Ortop 2019; 54:45-52. [PMID: 31363242 PMCID: PMC6424811 DOI: 10.1016/j.rbo.2017.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022] Open
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.
Collapse
|
16
|
Brophy RH, Huston LJ, Wright RW, Liu X, Amendola A, Andrish JT, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott ML, Wolf BR, Spindler KP. Patients treated with surgical irrigation and debridement for infection after ACL reconstruction have a high rate of subsequent knee surgery. J ISAKOS 2019. [DOI: 10.1136/jisakos-2018-000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
17
|
Kusnezov N, Eisenstein ED, Dunn JC, Wey AJ, Peterson DR, Waterman BR. Anterior Cruciate Ligament Graft Removal Versus Retention in the Setting of Septic Arthritis After Reconstruction: A Systematic Review and Expected Value Decision Analysis. Arthroscopy 2018; 34:967-975. [PMID: 29122433 DOI: 10.1016/j.arthro.2017.08.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide further guidance on the optimal decision between anterior cruciate ligament (ACL) graft removal versus retention in the setting of septic arthritis following reconstruction using an expected value decision analysis. METHODS A systematic review and expected value decision analysis and sensitivity analyses were performed to quantify the clinical decision. A decision tree was created with 5 outcomes of interest: nonoperative complications, revision surgery, early reoperation, late reoperation, and "well." Pooled probabilities of each outcome were generated through a systematic literature review. We included only peer-reviewed studies, published in English, with at least 6 months of follow-up. One hundred randomly selected volunteers were given descriptions of the clinical scenario, the 2 treatment options, and outcomes of interest. Patients younger than 18 and older than 50 years and those previously treated for either ACL injury or septic arthritis, or both, were excluded from the analysis to minimize bias. These hypothetical patients indicated preferences for each outcome on a visual analog scale and responses were averaged to generate overall "utility values." Fold-back analysis summed products of pooled outcomes probabilities with respective averaged utility values. The resulting overall expected values for graft removal and debridement were compared, with the highest expected value considered to be superior. We then performed 1-way sensitivity analyses to mitigate sample bias. RESULTS Fold-back analysis revealed graft removal to be strongly favored over retention, with overall expected values of 17.2 and 8.64, respectively. The most important contributor to the difference in overall expected values was late reoperation (8.59 vs 2.50 for removal and retention, respectively). Despite adjustments made to the rates of revision and early reoperation during the 1-way sensitivity analyses, graft removal remained the optimal strategy. CONCLUSIONS This expected value decision analysis revealed that ACL graft removal was strongly favored by patients over graft retention in the setting of postoperative septic arthritis when consideration was given to the probabilities of wellness, nonoperative complications, revision surgery, early reoperation, and late reoperation. Sensitivity analysis revealed that although variation in rates of other outcomes did not impact this preference, the rate of late reoperation had a substantial impact. Only a sizable increase in the probability of late reoperation (from 0% to 60%) after graft removal would cause potential patients to favor graft retention. LEVEL OF EVIDENCE Level IV, systematic review and decision analysis.
Collapse
Affiliation(s)
- Nicholas Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
| | - Emmanuel D Eisenstein
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
| | - John C Dunn
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
| | - Aaron J Wey
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
| | - David R Peterson
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A..
| | - Brian R Waterman
- Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, U.S.A
| |
Collapse
|
18
|
Waterman BR, Arroyo W, Cotter EJ, Zacchilli MA, Garcia EJ, Owens BD. Septic Arthritis After Anterior Cruciate Ligament Reconstruction: Clinical and Functional Outcomes Based on Graft Retention or Removal. Orthop J Sports Med 2018; 6:2325967118758626. [PMID: 29552571 PMCID: PMC5846937 DOI: 10.1177/2325967118758626] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: There remains a debate over whether to retain the index anterior cruciate ligament (ACL) graft in the setting of septic arthritis. Purpose: To evaluate and compare clinical outcomes for the treatment of septic arthritis after ACL reconstruction (ACLR) in those with and without early graft retention. Study Design: Case series; Level of evidence, 4. Methods: The Military Health System was queried for all ACLR procedures performed between 2007 and 2013. Inclusion criteria required active military status, primary ACLR with secondary septic arthritis, and minimum 24-month surveillance. Demographic, clinical, and surgical variables were evaluated using descriptive statistics and regression analysis for factors influencing selected outcomes. Results: Of 9511 ACLR procedures, 31 (0.32%) were identified as having secondary septic arthritis requiring urgent arthroscopic irrigation and debridement and intravenous antibiotics (mean, 6.3 weeks). The majority (62%) were treated in the subacute (2 weeks to 2 months) setting. Index ACLR was performed with a hamstring autograft (n = 17, 55%), soft tissue allograft (n = 11, 35%), and patellar tendon autograft (n = 3, 10%). The graft was retained in 71% (n = 22) of patients, while 29% (n = 9) underwent early graft debridement. At a mean 26.9-month follow-up, 48% of patients (n = 15) had returned to the military. Graft removal was not predictive of return to active duty (P = .29). The presence of postoperative complications, including symptomatic postinfection arthritis (22.6%) and arthrofibrosis (9.7%), was the only variable predictive of inability to return to duty (odds ratio, 27.5 [95% CI, 3.24-233.47]; P = .002). Seven of 9 patients who underwent graft debridement underwent revision ACLR, and all 7 had stable knees at final follow-up compared with 68% (15/22) in the graft retention group. Conclusion: Arthroscopic debridement with early graft removal and staged revision ACLR remains a viable option for restoring knee stability (100%), although the rate of return to active duty was low in the graft resection group (33%). The risk of knee laxity did not differ based on early graft retention. Time to presentation with graft retention was not associated with a decreased rate of graft laxity.
Collapse
Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - William Arroyo
- Department of Orthopedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Eric J Cotter
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - E'Stephan J Garcia
- Department of Orthopedic Surgery, William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
19
|
Lobo P, Santos ED, Borges JHDES, Dias LJRV, Machado RDES, Freitas A. CONTRALATERAL PATELLAR TENDON AUTOGRAFT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION. ACTA ORTOPEDICA BRASILEIRA 2018; 26:140-144. [PMID: 29983633 PMCID: PMC6032619 DOI: 10.1590/1413-785220182602185594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To conduct a systematic review of literature about the use of contralateral patellar tendon autograft in anterior cruciate ligament reconstructions and present the results. METHODS The LILACS, MEDLINE, Cochrane, PubMed, Scielo and Google Scholar databases were searched without date restrictions for the keywords "anterior cruciate ligament reconstruction" combined with "contralateral" in the article title. After the studies were identified, two independent evaluators collected the qualitative characteristics of the studies and classified them according to clinical outcomes of these grafts as positive, neutral, or negative. RESULTS A total of 755 articles were found initially, and after detailed evaluation of all references, followed by a screening process and assessment of quality, a total of 11 studies were determined to be eligible for inclusion in this systematic review. Of these, 72.72% were level II studies, the most common level of evidence among the results. Positive results for this type of graft were found in 63.63% of the studies. CONCLUSION Based on the literature review, most of the included articles (63.63%) presented positive results for the use of contralateral patellar tendon grafts. Level of Evidence III; Systematic review.
Collapse
Affiliation(s)
- Paulo Lobo
- . IPE-HOME, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brazil
| | - Eugênio Dos Santos
- . IPE-HOME, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brazil
| | | | | | | | - Anderson Freitas
- . IPE-HOME, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brazil
| |
Collapse
|
20
|
Park CH, Lee WC. Donor Site Morbidity After Lateral Ankle Ligament Reconstruction Using the Anterior Half of the Peroneus Longus Tendon Autograft. Am J Sports Med 2017; 45:922-928. [PMID: 27899356 DOI: 10.1177/0363546516675167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The anterior half of the peroneus longus tendon (AHPLT) has been reported to be an effective autograft for ligament reconstruction with respect to strength and safety. However, there is little information regarding donor site morbidity after harvesting the AHPLT. Furthermore, to the best of our knowledge, there has not been a study on the isokinetic evaluation of ankle plantar flexion and eversion after AHPLT harvesting. PURPOSE To evaluate the clinical and radiographic results after lateral ankle ligament reconstruction using the AHPLT. We further investigated whether harvesting the AHPLT for lateral ankle ligament reconstruction decreases the strength of ankle plantar flexion and eversion. STUDY DESIGN Case series; Level of evidence, 4. METHODS Thirty consecutive patients (31 cases) were treated by anatomic lateral ligament reconstruction using the AHPLT. For the clinical assessment, visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson-Peterson scores were evaluated preoperatively and at the last follow-up. For the radiographic assessment, talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. The peak isokinetic torques for ankle plantar flexion at angular velocities of 30 and 120 deg/s and eversion at angular velocities of 30 and 60 deg/s were measured at a minimum of 1 year after surgery. RESULTS The mean VAS score improved significantly from 6.4 ± 1.7 preoperatively to 1.6 ± 1.5 at the last follow-up ( P < .001). The mean respective AOFAS and Karlsson-Peterson scores improved significantly from 57.2 ± 12.8 and 66.9 ± 13.6 preoperatively to 89.0 ± 10.0 and 93.3 ± 5.7 at the last follow-up ( P < .001). The mean talar tilt angle improved significantly from 15.3° ± 6.2° preoperatively to 3.4° ± 3.0° at the last follow-up ( P < .001), and the mean anterior talar displacement improved significantly from 10.2 ± 3.3 mm preoperatively to 6.3 ± 1.9 mm at the last follow-up ( P < .001). No significant differences were observed between the uninvolved and involved legs in the mean peak torque for plantar flexion at angular speeds of 30 deg/s ( P = .517) and 120 deg/s ( P = .347) or for eversion at angular speeds of 30 deg/s ( P = .913) and 60 deg/s ( P = .983). CONCLUSION Anatomic lateral ligament reconstruction using the AHPLT showed good clinical and radiographic results without a significant decrease in the peroneus longus strength. Lateral ligament reconstruction using the AHPLT may be a good surgical option for the treatment of chronic ankle instability.
Collapse
Affiliation(s)
- Chul Hyun Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Woo-Chun Lee
- Seoul Foot and Ankle Center, Inje University Seoul Paik Hospital, Seoul, Korea
| |
Collapse
|
21
|
Warren DK, Nickel KB, Wallace AE, Mines D, Fraser VJ, Olsen MA. Can additional information be obtained from claims data to support surgical site infection diagnosis codes? Infect Control Hosp Epidemiol 2016; 35 Suppl 3:S124-32. [PMID: 25222891 DOI: 10.1086/677830] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes are increasingly used to identify healthcare-associated infections, often with insufficient evidence demonstrating validity of the codes used. Absent medical record verification, we sought to confirm a claims algorithm to identify surgical site infections (SSIs) by examining the presence of clinically expected SSI treatment. METHODS We performed a retrospective cohort study, using private insurer claims data from persons less than 65 years old with ICD-9-CM procedure or Current Procedure Terminology (CPT-4) codes for anterior cruciate ligament (ACL) reconstruction from January 2004 through December 2010. SSIs occurring within 90 days after ACL reconstruction were identified by ICD-9-CM diagnosis codes. Antibiotic utilization, surgical treatment, and microbiology culture claims within 14 days of SSI codes were used as evidence to support the SSI diagnosis. RESULTS Of 40,702 procedures, 401 (1.0%) were complicated by SSI, 172 (0.4%) of which were specifically identified as septic arthritis. Most SSIs were associated with an inpatient admission (232/401 [58%]), and/or surgical procedure(s) for treatment (250/401 [62%]). Temporally associated antibiotics, surgical treatment procedures, and cultures were present for 84% (338/401), 61% (246/401), and 59% (238/401), respectively. Only 5.7% (23/401) of procedures coded for SSI after the procedure had no antibiotics, surgical treatments, or cultures within 14 days of the SSI claims. CONCLUSIONS More than 94% of patients identified by our claims algorithm as having an SSI received clinically expected treatment for infection, including antibiotics, surgical treatment, and culture, suggesting that this algorithm has very good positive predictive value. This method may facilitate retrospective SSI surveillance and comparison of SSI rates across facilities and providers.
Collapse
Affiliation(s)
- David K Warren
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | | | | | | | | | | |
Collapse
|
22
|
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; 43:3005-12. [PMID: 26403209 DOI: 10.1177/0363546515603054] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but severe complication. Treatment regimens differ, and optimal management has not been established. PURPOSE To determine the incidence of postoperative infections after ACL reconstruction, to identify the microbiological spectrum, and to evaluate a standardized graft-retaining treatment protocol consisting of sequential arthroscopic irrigation and debridement (I&D) procedures and antibiotic therapy until C-reactive protein levels are within normal range. STUDY DESIGN Case series; Level of evidence, 4. METHODS From January 2004 to June 2014, a total of 7096 consecutive arthroscopic ACL reconstructions were performed at a single institution (5907 primary and 1189 revision reconstructions). Thirty-six cases with postoperative septic arthritis were identified and retrospectively analyzed with regard to incidence, clinical presentation, time to and number of arthroscopic reoperations, and microbiological findings. The follow-up examination consisted of a clinical examination, instrumeted measurement of laxity (KT-1000 arthrometer), classification according to objective and subjective International Knee Documentation Committee (IKDC) scores, and radiological evaluation. RESULTS The incidence of septic arthritis was 0.51% (n = 36), with 0.41% (n = 24) in primary and 1.01% (n = 12) in revision reconstructions (odds ratio, 2.5; P = .008). The first I&D was performed a mean (± SD) of 19.6 ± 10.6 days after the index procedure. Eradication was achieved in all patients after a mean of 2.25 ± 1.22 procedures, with graft retention in all but 1 patient (97.2%). The mean duration of antibiotic treatment was 5.4 ± 2.3 weeks (range, 2.1-12.9 weeks) and ≤ 4 weeks in 13 patients (36%). No recurrence of infections was seen. Coagulase-negative staphylococci (62.5%) and Staphylococcus aureus (21.9%) were the most frequent pathogens. Twenty-nine patients were available for follow-up (80.6%) after a mean 4.7 ± 3.2 years (range, 0.7-11.2 years). Two patients suffered recurrent nontraumatic ACL insufficiency (6.9%), and all others (93.1%) had an intact graft, with a mean KT-1000 arthrometer side-to-side difference of 1.4 ± 0.9 mm. The mean subjective IKDC score was 80.4 ± 11.2. No emergence or deterioration of osteoarthritis related to infections was seen. CONCLUSION Postoperative septic arthritis is rare but serious after arthroscopic ACL reconstruction. Graft retention and good to excellent clinical results can be obtained with an arthroscopic treatment protocol. The duration of antibiotic therapy should be based on the individual course.
Collapse
Affiliation(s)
- Philipp Schuster
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Martin Schulz
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Micha Immendoerfer
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Philipp Mayer
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Michael Schlumberger
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| | - Joerg Richter
- Centre for Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany
| |
Collapse
|
23
|
Cottino U, Rosso F, Pastrone A, Dettoni F, Rossi R, Bruzzone M. Painful knee arthroplasty: current practice. Curr Rev Musculoskelet Med 2015; 8:398-406. [PMID: 26400422 DOI: 10.1007/s12178-015-9296-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.
Collapse
Affiliation(s)
- Umberto Cottino
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federica Rosso
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Antonio Pastrone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federico Dettoni
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Roberto Rossi
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Matteo Bruzzone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| |
Collapse
|
24
|
Makhni EC, Steinhaus ME, Mehran N, Schulz BS, Ahmad CS. Functional Outcome and Graft Retention in Patients With Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy 2015; 31:1392-401. [PMID: 25727493 DOI: 10.1016/j.arthro.2014.12.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/30/2014] [Accepted: 12/30/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a comprehensive review of clinical and functional outcomes after treatment for septic arthritis after anterior cruciate ligament reconstruction. METHODS A systematic review of the literature was performed. Two reviewers assessed and confirmed the methodologic quality of each study. Studies that met the inclusion criteria were assessed for pertinent data, and when available, similar outcomes were combined to generate frequency-weighted means. RESULTS Nineteen studies met the inclusion and exclusion criteria for this review, reporting on a total of 203 infected knees. The mean age was 27.5 years and the mean length of follow-up was 44.2 months, with male patients comprising 88% of the population. Hamstring and bone-patellar tendon-bone autografts were used in 63% and 33% of patients, respectively, with 78% of patients retaining their grafts. The studies reported mean flexion and extension deficits of 5.8° and 1.0°, respectively, and laxity testing showed a mean difference of 1.9 mm. The studies reported mean Lysholm, International Knee Documentation Committee, and Tegner scores of 82.1, 68.2, and 5.6, respectively. Of the patients, 83% reported an ability to return to activities of daily living whereas 67% reported a return to their preinjury level of athletics. Evidence of new degenerative changes was seen in 22% of patients. CONCLUSIONS Septic arthritis after anterior cruciate ligament reconstruction remains a very infrequent event, affecting 0.5% of patients. On average, outcomes in these patients are comparable with those in patients in whom infection does not develop, including postoperative range of motion, residual instability, Lysholm scores, and return to preinjury level of activity. These patients do exhibit decreased International Knee Documentation Committee scores compared with patients without septic arthritis, however. The impact of this differential is not clear, but this scoring difference suggests that septic arthritis may be associated with more severe symptoms and reduced functional outcomes. In addition, there is limited evidence suggesting that septic arthritis leads to early degenerative changes found on imaging. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Eric C Makhni
- Columbia University Medical Center, New York, New York, U.S.A
| | | | - Nima Mehran
- Henry Ford Hospital, Wayne State University, Detroit, Michigan, U.S.A
| | - Brian S Schulz
- Kerlan-Jobe Orthopedic Clinic, Los Angeles, California, U.S.A
| | | |
Collapse
|
25
|
Wang C, Lee YHD, Siebold R. Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22:2136-44. [PMID: 24061716 DOI: 10.1007/s00167-013-2648-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 08/24/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the current evidence for the management of septic arthritis after anterior cruciate ligament (ACL) reconstruction, the factors that affect the outcome after treatment and the retention of graft and implants. METHODS A systematic literature search of the PubMed database was performed on septic arthritis after ACL reconstruction. A total of 301 publications were initially identified, and 17 papers were found to fulfil the criteria to be included in the review. RESULTS There were 196 cases of septic arthritis after ACL reconstruction in over 30,000 ACL reconstructions, making the proportion of infection 0.6%. Most patients (114/123, 92.6%) had an acute or subacute infection at an average of 16.8 ± 10.5 days after ACL reconstruction. Coagulase-negative Staphylococci (CNS) was the most common organism (67/147, 45.6%) followed by Staphylococcus aureus (SA) (35/147, 23.8%); 86.9% underwent surgical treatment of which 92.8% had an average of 1.54 (up to 4) arthroscopic debridements. The group with SA infection had a higher graft removal rate (33.3%, p = 0.019), a longer antibiotic duration (35.4 days, p = 0.047) and a worse range of flexion (111.5°, p = 0.036) than the CNS group. CONCLUSIONS CNS was the most common organism in septic arthritis after ACL reconstruction followed by SA. For most authors, arthroscopic debridement combined with intravenous antibiotic therapy was the initial treatment of choice. Antibiotic therapy with or without multiple irrigations of the joint is not recommended based on the high failure rates. Delayed diagnosis of more than 7 days or SA infection required a longer duration of antibiotic therapy and increased the likelihood for graft removal and restricted range of motion. Fungal infection and tubercular infection had a high prevalence of late diagnosis and open debridement. LEVEL OF EVIDENCE Systematic review, Level IV.
Collapse
Affiliation(s)
- Cheng Wang
- Institute of Sports Medicine, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | | | | |
Collapse
|
26
|
Wang C, Ao Y, Fan X, Wang J, Cui G, Hu Y, Yu J. C-reactive protein and erythrocyte sedimentation rate changes after arthroscopic anterior cruciate ligament reconstruction: guideline to diagnose and monitor postoperative infection. Arthroscopy 2014; 30:1110-5. [PMID: 24863405 DOI: 10.1016/j.arthro.2014.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 03/12/2014] [Accepted: 03/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of our study were to determine normative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values from a retrospective review of patients with and without infection after anterior cruciate ligament (ACL) reconstruction and to determine CRP and ESR threshold levels that can serve as diagnostic indicators of infection. We also tried to draw a curve of CRP and ESR value changes after treatment of ACL infection to evaluate the response to treatment of the infection. METHODS A retrospective chart review was performed of arthroscopic ACL reconstruction patients from 2007 to 2008 (noninfection group) and all patients with postoperative intra-articular infection from 1997 to 2010 (infection group). We collected the CRP and ESR values on the third and fifth postoperative days in the noninfection group and before infection treatment and on the first, third, fifth, seventh, 10th, 14th, 21st, 28th, and 35th days after infection treatment in the infection group. Sensitivity, specificity, and Youden's index were calculated for different threshold values of CRP and ESR as predictors of infection. Receiver operator curves were obtained for CRP and ESR on the fifth postoperative day. RESULTS Of 122 patients, 83 had normal joints and 39 had septic joints. The mean CRP and ESR values in patients with septic joints were 101.9 mg/L and 57.1 mm/h, respectively, which were significantly higher than those in the noninfection group (P < .01). A CRP value of 41 mg/L and ESR value of 32 mm/h were the optimal thresholds to predict an infection, which had the highest Youden's index of all calculated values and had sensitivity values of 94.1% and 91.2%, respectively, and specificity values of 97.6% and 80.5%, respectively. The peak CRP level after infection treatment occurred earlier than the peak ESR level (first day v third day) and returned to normal more quickly (21st day v 28th day). CONCLUSIONS Both CRP and ESR were helpful in determining the presence of a normal or septic joint. The threshold values of 41 mg/L for CRP and 32 mm/h for ESR had the most optimal sensitivity and specificity. The peak CRP level occurred earlier than the peak ESR level after treatment of postoperative infection and returned to normal more quickly. In this study CRP was more useful than ESR to evaluate the response of infection to treatment. LEVEL OF EVIDENCE Level IV, diagnostic study.
Collapse
Affiliation(s)
- Cheng Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yingfang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaohua Fan
- Orthopaedics Department, Yidu Central Hospital of Weifang, Shandong, China
| | - Jianquan Wang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Yuelin Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Jiakuo Yu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
27
|
Shelbourne KD, Benner RW, Gray T. Return to Sports and Subsequent Injury Rates After Revision Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft. Am J Sports Med 2014; 42:1395-400. [PMID: 24627577 DOI: 10.1177/0363546514524921] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The return-to-sport and reinjury rates are not well defined after revision anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS School-age athletes would have a higher rate of return to sports and reinjury to either knee after revision ACL surgery compared with college or recreational athletes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients were prospectively studied after revision ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft. Participants were grouped by competitive sport levels of school age (mean age, 16.6 ± 0.9 years; n = 84), college (19.6 ± 1.2 years; n = 58), or recreational adult (27.6 ± 4.1 years; n = 117). An activity survey was used to determine the specific sport and sport level patients participated in before and after surgery. The International Knee Documentation Committee (IKDC) knee survey and Cincinnati Knee Rating System (CKRS) survey responses were also obtained. RESULTS The rate of return to the same sport at the same level was 62 of 84 school-age athletes (74%), 43 of 58 college athletes (74%), and 73 of 117 recreational athletes (62%) (P = .1065). The number of patients who had a subsequent ACL graft tear rate after revision surgery was 2 of 84 (2.3%) in the high school group, 3 of 58 (5.1%) in the college group, and 4 of 117 (3.4%) in the recreational group (P = .6706). The number of patients who had a subsequent ACL tear in the contralateral knee was 1 of 84 (1.1%) in the school-age group, 1 of 58 (1.7%) in the college group, and 2 of 117 (1.7%) in the recreational group (P = .9501). At 2 years postoperatively, the mean IKDC subjective total score was 86.1 ± 11.7 points and the mean CKRS total score was 89.7 ± 11.1 points. CONCLUSION Revision ACL reconstruction with BPTB autograft and perioperative rehabilitation allowed high school and college athletes to return to sports at the preinjury level at a rate of 74%; the return rate for recreational-level adults was 62%. Reinjury rates in the first 5 years after revision surgery ranged from 2% to 5%, which is lower than what has been reported for young competitive athletes after primary surgery.
Collapse
Affiliation(s)
| | | | - Tinker Gray
- Shelbourne Knee Center, Indianapolis, Indiana, USA
| |
Collapse
|
28
|
Hettrich CM, Dunn WR, Reinke EK, Spindler KP. The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 2013; 41:1534-40. [PMID: 23722056 PMCID: PMC4195486 DOI: 10.1177/0363546513490277] [Citation(s) in RCA: 213] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subsequent surgeries have a profound effect on patient satisfaction and outcome after primary anterior cruciate ligament reconstruction (ACLR). There have been no prospective studies to date describing the rate and predictors (surgical and patient variables) of all subsequent knee surgeries at short-term and midterm follow-up along with analyses of surgical and patient variables that are associated with subsequent surgeries. PURPOSE To report the rate and predictors of all subsequent surgeries at short-term and midterm follow-up along with associated patient variables. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 980 patients (540 male) were prospectively enrolled in a Multicenter Orthopaedic Outcomes Network (MOON) cohort from January 2002 to December 2003. The 2- and 6-year follow-up information for subsequent procedures was obtained. Operative reports were obtained, and all procedures were categorized. RESULTS One hundred eighty-five patients underwent a subsequent surgery on the ipsilateral leg (18.9%) and 100 on the contralateral knee (10.2%) at 6-year follow-up. On the ipsilateral knee, there was a 7.7% rate of ACL revisions, a 13.3% rate of cartilage procedures, a 5.4% rate of arthrofibrosis procedures, and a 2.4% rate of procedures related to hardware. For the contralateral knee, there was a 6.4% rate of primary ACL ruptures. Younger age at the index surgery and the use of allografts were predictors (risk factors) for subsequent surgery. Revision ACLR, female sex, body mass index, and surgical exposure were not significant predictors. CONCLUSION At 6-year follow-up, 18.9% of patients who had undergone ACLR underwent subsequent surgeries on the ipsilateral knee. The rates between an ipsilateral ACLR graft versus a contralateral normal ACL tear were similar (7.7% vs 6.4%, respectively). Younger age and the use of allografts were risk factors for subsequent surgery.
Collapse
|
29
|
Duncan IC, Kane PW, Lawson KA, Cohen SB, Ciccotti MG, Dodson CC. Evaluation of information available on the Internet regarding anterior cruciate ligament reconstruction. Arthroscopy 2013; 29:1101-7. [PMID: 23591383 DOI: 10.1016/j.arthro.2013.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 02/01/2013] [Accepted: 02/08/2013] [Indexed: 02/02/2023]
Abstract
Searching the Internet is one of the most popular methods for acquiring information related to health. The Internet offers physicians and patients easy access to a wide range of medical material from anywhere in the world. For many patients, this information helps formulate decisions related to their health and health care. An important caveat is that virtually anything can be published on the Internet. Although academic publications require rigorous peer review, Internet websites have no regulatory body monitoring quality and content. With a lack of external regulation, the information retrieved may be incorrect or outdated. The Internet can be a valuable asset for educating patients, but because of significant variability physicians should be familiar with the quality of information available. This article discusses both the strengths and weaknesses of information available on the Internet regarding anterior cruciate ligament repair.
Collapse
Affiliation(s)
- Ian C Duncan
- The Rothman Institute, Thomas Jefferson Sports Medicine Division, Philadelphia, PA 19010, USA
| | | | | | | | | | | |
Collapse
|
30
|
Benner RW, Shelbourne KD, Urch SE, Lazarus D. Tear patterns, surgical repair, and clinical outcomes of patellar tendon ruptures after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft. Am J Sports Med 2012; 40:1834-41. [PMID: 22707748 DOI: 10.1177/0363546512449815] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendon ruptures are rare after graft harvest for anterior cruciate ligament (ACL) reconstruction. Few reports are available in the literature. PURPOSE To report the common tear patterns and results of treatment with tendon repair and cable augmentation. STUDY DESIGN Case series; Level of evidence, 4. METHODS All tendon ruptures were repaired to bone with suture anchors and augmented with a Dall-Miles cable, followed by an aggressive rehabilitation protocol. The tear location was recorded. Range of motion, strength, and subjective survey testing were conducted preoperatively and postoperatively. RESULTS Thirteen patellar tendon ruptures were found from our database of 5364 ACL reconstructions, for an incidence of 0.24%. Seven ruptures occurred from the patellar origin medially and the tibial attachment laterally in a Z-shaped pattern. Four were completely distal, and 2 were completely proximal ruptures. All patients exhibited early flexion loss, but 11 of 13 patients maintained full, terminal hyperextension throughout treatment. The mean postoperative side-to-side flexion deficit was 33° at 1 month, 6° at 3 months, and 3° at latest follow-up at a mean of 4.8 years after tendon repair (range, 1-16 years). By International Knee Documentation Committee (IKDC) criteria, 10 patients had normal flexion, and 3 were nearly normal at latest follow-up. Twelve patients had normal extension, and 1 had nearly normal extension at latest follow-up. Mean isokinetic quadriceps muscle strength was 68.7% of the other side at 3 months after repair and 100.0% at latest follow-up, occurring at a mean of 47.5 months (range, 12-120 months). At a mean of 2 years (range, 1-4 years) after repair, the mean modified Noyes subjective score was 89.8 ± 9.2. CONCLUSION Patellar tendon ruptures are rare after ACL graft harvest. These ruptures usually occur in either a proximal-medial and distal-lateral pattern or an entirely distal pattern, in contrast to the proximal-only tear pattern commonly observed in unharvested patellar tendons. Good objective and subjective results were achieved with repair of postoperative patellar tendon ruptures using suture anchors and Dall-Miles cable augmentation, followed by aggressive, immediate range of motion exercises.
Collapse
Affiliation(s)
- Rodney W Benner
- Campbell Clinic, Department of Orthopaedic Surgery, University of Tennessee, Memphis, Tennessee, USA
| | | | | | | |
Collapse
|
31
|
Zhao J, Huangfu X. The biomechanical and clinical application of using the anterior half of the peroneus longus tendon as an autograft source. Am J Sports Med 2012; 40:662-71. [PMID: 22174343 DOI: 10.1177/0363546511428782] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The shortage of autogenous grafts has often times been a problem in knee ligament reconstruction. There are little data concerning the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft. HYPOTHESIS The AHPLT is a suitable graft with respect to its strength, safety, and donor site morbidity. STUDY DESIGN Descriptive laboratory study and case series; Level of evidence, 4. METHODS The safety and efficacy of using the AHPLT as an autograft source were evaluated. A cadaveric study was first done to reveal the anatomic profile of the AHPLT, to test its failure load, and to compare it with that of the semitendinosus and gracilis tendons. Then, a cadaveric harvest study was performed to show it was safe and reproducible. The space between the tendon stripper and the peroneal nerve during harvesting of the AHPLT was evaluated. Lastly, a clinical study was performed to evaluate donor site morbidity. The preoperative and postoperative foot and ankle functions of 92 patients who underwent a variety of knee ligament reconstructions with the AHPLT were followed for more than 2 years and were then evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) to determine the influence of tendon removal on ankle and foot function. RESULTS The average failure load of the AHPLT was 322.35 ± 63.18 N, accounting for 97.69% ± 19.48% and 147.94% ± 41.30% of the semitendinosus and gracilis tendons, respectively. During tendon harvesting, the distance between the head of the tendon stripper and the branching point of the deep peroneus nerve was 4.6 to 10.4 cm. The clinical study showed that the preoperative and postoperative AOFAS scores were 97.4 ± 2.0 and 97.2 ± 1.6 (P = .85), respectively, while the FADI scores preoperatively and postoperatively were 96.8 ± 2.2 and 96.9 ± 2.5 (P = .91), respectively. No signs of peroneus nerve injury, peroneus longus tendon rupture, or tendinopathy were found. CONCLUSION The AHPLT is acceptable for use as an autograft with respect to its strength, safety, and donor site morbidity.
Collapse
Affiliation(s)
- Jinzhong Zhao
- Department of Arthroscopic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, 600 Yishan Road, Shanghai 200233, China.
| | | |
Collapse
|