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Effect of Joint Infection After Arthroscopic Single-Bundle ACL Reconstruction With Autologous Hamstring Tendon: A
Nayun Chen1,2, Cheng Wang1,2, Dai Li1,2
1Department of Sports Medicine, Peking University Third Hospital, Beijing, China.
Background:
Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but serious complication.
Purpose:
To assess the effect of joint infection on the graft, cartilage, and bone tunnel using magnetic resonance imaging (MRI) after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendons.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
This retrospective matched cohort study included 26 patients who underwent arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at the authors' institute between January 2002 and December 2017 and developed postoperative joint infection. These patients were matched 1:3 to patients who did not sustain joint infection after ACL reconstruction (control group). MRI scans were collected at the time of follow-up. The following parameters were evaluated: graft signal-to-noise quotient (SNQ); graft signal intensity at the bone-graft interface and within the knee joint; bone tunnel enlargement at the tunnel aperture, midsection, and exit of the tibial and femoral tunnels; and cartilage integrity.
Results:
The average follow-up time was 47.8 months in the infection group and 48.5 months in the control group. Compared with the control group, the infection group had a significantly higher SNQ (20.01 ± 12.08 vs 7.61 ± 6.70; P = .014) as well as a higher signal intensity at the bone-graft interface (P = .037) and higher Howell grade (P = .031). The mean enlargement at the femoral tunnel aperture was 31.20% ± 26.76% in the infection group and 19.22% ± 20.10% in the control group (P = .037). The articular cartilage of the patellofemoral and lateral femorotibial joints showed more degenerative change in the infection group.
Conclusion:
Study findings indicated that graft ligamentization and incorporation graft maturity were inferior in patients who experienced a joint infection after ACL reconstruction compared with patients who did not.
Insights
Joint infection after anterior cruciate ligament (ACL) reconstruction impairs graft healing and maturity. Magnetic resonance imaging (MRI) revealed inferior graft ligamentization and incorporation in infected patients compared to controls.
Area of Science:
- Orthopedic surgery
- Medical imaging
- Infectious diseases
Background:
- Postoperative joint infection is a rare but serious complication following anterior cruciate ligament (ACL) reconstruction.
- Understanding the long-term effects of infection on surgical outcomes is crucial for patient management.
Purpose of the Study:
- To evaluate the impact of joint infection on ACL graft healing, cartilage integrity, and bone tunnel remodeling.
- To utilize magnetic resonance imaging (MRI) for objective assessment after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendons.
Main Methods:
- A retrospective matched cohort study compared 26 patients with postoperative joint infection to a 1:3 control group without infection.
- MRI scans were analyzed for graft signal-to-noise quotient (SNQ), bone-graft interface signal intensity, bone tunnel enlargement, and cartilage integrity.
Main Results:
- The infection group exhibited significantly higher SNQ, increased bone-graft interface signal intensity, and greater femoral tunnel aperture enlargement compared to controls.
- Degenerative changes in articular cartilage were more pronounced in the patellofemoral and lateral femorotibial joints of the infection group.
Conclusions:
- Postoperative joint infection negatively affects graft ligamentization and incorporation following ACL reconstruction.
- MRI findings suggest impaired graft maturity and accelerated joint degeneration in patients who develop infection.
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