Instrumentation-specific infection after anterior cruciate ligament reconstruction

Stephen Parada, Jason A. Grassbaugh, John Glenden DeVine, Edward D. Arrington

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

Background: Anterior cruciate ligament (ACL) reconstruction is uncommonly complicated by postoperative infections, the causes of which are rarely identified. Hypothesis/Purpose: The goal of this study was to characterize the relationship between methodological sterilization failure and ACL reconstruction infection at an army medical center. Study Design: Case series. Methods: Demographic, clinical, and laboratory data were collected on 5 postoperative infections during a 14-week period in 2003. All ACL reconstructions completed within the past 6 years at the institution were reviewed to establish a baseline infection rate. Results: There was a 14-week period in which 5 cases of infection occurred postoperatively, an infection rate of 12.2%. Previous and subsequent to the identified period, the established rate of infection after ACL reconstruction was 0.3%. There were no violations of sterile technique noted in any of the identified cases. All cases utilized hamstring autograft. All cases also used the DePuy Mitek Intrafix system for tibial fixation of the graft. Two of these cases had positive cultures. Conclusions: An isolated series of increased infection rate led to an investigation into the sterile technique. This revealed gross biomaterial remaining inside instrumentation common to all the cases, the DePuy Mitek Intrafix system. The modular cannulated hex driver, made to fit over a small caliber wire, had no wire brushes of a small-enough diameter for the cleaning and sterilization procedure. After recognition of infection, all patients were treated with surgical irrigation and debridement of the affected knee, as well as individualized antibiotic therapy. Patients were followed postoperatively and no patients required revision ACL reconstruction or radical debridement of the graft.

Original languageEnglish (US)
Pages (from-to)481-485
Number of pages5
JournalSports Health
Volume1
Issue number6
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

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Anterior Cruciate Ligament Reconstruction
Infection
Debridement
Transplants
Autografts
Biocompatible Materials
Knee
Demography
Anti-Bacterial Agents

Keywords

  • Anterior cruciate ligament
  • Postoperative infection
  • Surgical site infections

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Instrumentation-specific infection after anterior cruciate ligament reconstruction. / Parada, Stephen; Grassbaugh, Jason A.; DeVine, John Glenden; Arrington, Edward D.

In: Sports Health, Vol. 1, No. 6, 01.11.2009, p. 481-485.

Research output: Contribution to journalReview article

Parada, Stephen ; Grassbaugh, Jason A. ; DeVine, John Glenden ; Arrington, Edward D. / Instrumentation-specific infection after anterior cruciate ligament reconstruction. In: Sports Health. 2009 ; Vol. 1, No. 6. pp. 481-485.
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abstract = "Background: Anterior cruciate ligament (ACL) reconstruction is uncommonly complicated by postoperative infections, the causes of which are rarely identified. Hypothesis/Purpose: The goal of this study was to characterize the relationship between methodological sterilization failure and ACL reconstruction infection at an army medical center. Study Design: Case series. Methods: Demographic, clinical, and laboratory data were collected on 5 postoperative infections during a 14-week period in 2003. All ACL reconstructions completed within the past 6 years at the institution were reviewed to establish a baseline infection rate. Results: There was a 14-week period in which 5 cases of infection occurred postoperatively, an infection rate of 12.2{\%}. Previous and subsequent to the identified period, the established rate of infection after ACL reconstruction was 0.3{\%}. There were no violations of sterile technique noted in any of the identified cases. All cases utilized hamstring autograft. All cases also used the DePuy Mitek Intrafix system for tibial fixation of the graft. Two of these cases had positive cultures. Conclusions: An isolated series of increased infection rate led to an investigation into the sterile technique. This revealed gross biomaterial remaining inside instrumentation common to all the cases, the DePuy Mitek Intrafix system. The modular cannulated hex driver, made to fit over a small caliber wire, had no wire brushes of a small-enough diameter for the cleaning and sterilization procedure. After recognition of infection, all patients were treated with surgical irrigation and debridement of the affected knee, as well as individualized antibiotic therapy. Patients were followed postoperatively and no patients required revision ACL reconstruction or radical debridement of the graft.",
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