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Published on: April 30, 2014
Intra-operative hamstring tendon graft contamination in anterior cruciate ligament reconstruction
Iosif Gavriilidis1, Emilios E Pakos, Benjamin Wipfler
1ATOS Clinic, Center for Foot and Knee Surgery, Sport Surgery, Heidelberg, Germany.
Insights
Hamstring tendon grafts in anterior cruciate ligament reconstructions can become contaminated, but this did not lead to clinical infection. Elevated C-reactive protein (CRP) levels were noted in contaminated grafts.
Area of Science:
- Orthopedic Surgery
- Microbiology
- Biomaterials Science
Background:
- Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure.
- Hamstring tendons are frequently used as autografts for ACL reconstruction.
- Concerns exist regarding potential graft contamination during ACL reconstruction surgery.
Purpose of the Study:
- To assess the incidence of hamstring tendon contamination during ACL reconstruction.
- To investigate the correlation between graft contamination and clinical infection.
- To examine the association of graft contamination with inflammatory markers, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
Main Methods:
- Prospective study involving 89 patients undergoing ACL reconstruction.
- Two graft tissue samples collected for bacterial culture: pre-implantation and post-harvesting.
- Preoperative and postoperative (4th and 20th day) evaluation of CRP and ESR levels.
Main Results:
- Ten percent (9/89) of grafts showed positive cultures, indicating contamination.
- No patients exhibited clinical signs of postoperative infection.
- All patients showed elevated CRP and ESR levels on postoperative day 4, returning to normal by day 20.
- Patients with contaminated grafts had higher mean CRP levels on postoperative day 4 compared to those with uncontaminated grafts.
Conclusions:
- Hamstring tendon contamination is possible during ACL reconstruction but does not necessarily result in clinical infection.
- Elevated CRP levels on postoperative day 4 may indicate graft contamination.
- Standard inflammatory markers (CRP and ESR) normalize by postoperative day 20, regardless of graft contamination status.
Abstract:
We aimed to evaluate the possibility of hamstring tendon contamination, the correlation with clinical infection and its association with C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values in 89 anterior cruciate ligament reconstructions. Two tissue samples were obtained for culture from each graft: immediately after harvesting the graft and before implantation. The ESR and the CRP were evaluated preoperatively and on the 4th and 20th postoperative days. Nine patients (10%) had positive cultures but no patient had signs of postoperative infection. All patients had ESR and CRP values elevated at the 4th postoperative day. ESR and CRP values returned to normal levels at the 20th postoperative day. Higher mean values of CRP levels at the 4th day were observed in patients with contaminated grafts compared to those with uncontaminated. Both values reached normal levels at the 20th postoperative day.
