Screw and Sheath Tibial Fixation Associated With a Higher Likelihood of Deep Infection After Hamstring Graft Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 48 (4) ◽  
pp. 806-811
Author(s):  
Andrew P. Hurvitz ◽  
Heather A. Prentice ◽  
Tadashi T. Funahashi ◽  
Gregory B. Maletis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Reference Group ◽  
Cruciate Ligament ◽  
Deep Infection ◽  
Single Bundle ◽  
Hamstring Autograft ◽  
Kaiser Permanente ◽  
Level Of Evidence ◽  
Tibial Fixation ◽  
Anterior Cruciate

Background: Hamstring autograft anterior cruciate ligament reconstructions (ACLRs) have exhibited higher infection rates compared with bone–patellar tendon–bone (BPTB) autograft. The reason for this observed difference is unclear, warranting investigation. Purpose: To evaluate the association between tibial fixation, either with or without a sheath and screw construct, and the risk of deep infection after hamstring autograft ACLR, using BPTB autograft as a reference group for comparison. Study Design: Cohort study; Level of evidence, 3. Methods: Using the Kaiser Permanente ACLR Registry, we identified all primary isolated, unilateral, single-bundle ACLRs with a BPTB or hamstring autograft (January 1, 2008, to September 30, 2016). The exposure groups included the following: (1) BPTB ACLR, (2) hamstring ACLR using a screw and sheath construct for tibial fixation (HS with screw and sheath), and (3) hamstring ACLR using a method other than a screw and sheath construct for tibial fixation (HS without screw and sheath). We used logistic regression to evaluate the likelihood of 90-day postoperative deep infection using BPTB autograft as the reference group and adjusting for age, sex, and body mass index. The number needed to be exposed (NNE) was calculated. Results: Of 15,671 ACLRs, 6745 (43.0%) used a BPTB graft, 2852 (18.2%) used HS with screw and sheath tibial fixation, and 6074 (38.8%) used HS without screw and sheath tibial fixation. There were 38 (0.2%) 90-day deep infections: 11 (0.2%) for BPTB, 14 (0.5%) for HS with screw and sheath, and 13 (0.2%) for HS without screw and sheath. Staphylococcus aureus for the BPTB group and Staphylococcus epidermidis in both hamstring groups were the most common infecting organisms. HS with screw and sheath had a higher likelihood of 90-day deep infection compared with BPTB ACLR (odds ratio [OR], 2.87; 95% CI, 1.29-6.38). We failed to observe a difference for HS without screw and sheath compared with BPTB ACLR (OR, 1.23; 95% CI, 0.54-2.77). The NNE was 330 and 2701 for HS with and HS without screw and sheath, respectively. Conclusion: Although the overall infection rate after ACLR is low, the higher likelihood of infections when sheath and screw combined are used for tibial fixation of a hamstring autograft ACLR should be a consideration when this procedure is performed.

scholarly journals Higher Rate of Patellofemoral Problems After Anterior Cruciate Ligament Reconstruction using Hamstring Autograft

2021 ◽  
Vol 9 (B) ◽  
pp. 811-815
Author(s):  
Krisna Yuarno Phatama ◽  
Romy Darmawansa ◽  
I Gusti Ngurah Arga Aldrian Oktafandi ◽  
Felix Cendikiawan ◽  
Alva Pribadi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Hamstring Autograft ◽  
Peroneus Longus Tendon ◽  
Peroneus Longus ◽  
Kujala Score ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Patellofemoral problems are not uncommon among post-anterior cruciate ligament (ACL) reconstruction patients. Hamstring autograft harvesting-related factor is one of the suspected causes. A lack of tibiofemoral internal rotation force due to strength deficit causes the patella tends to shift laterally. Purposes: Peroneus longus tendon has been proposed as an alternative graft source due to its adequate tensile strength and minimal donor site morbidity to the knee biomechanics, including the patellofemoral joint. This tendon does not cross the knee joint and thus does not affect patellofemoral alignment and biomechanics. This study aims to compare patellofemoral problems between hamstring and peroneus longus autograft harvested-patients following ACL reconstruction. Material and methods: Thirty-one subjects who underwent primary single-bundle ACL reconstruction between September 2018 and September 2019 and met the inclusion criteria were grouped into the hamstring group (n=16) and peroneus longus group (n=15). Both groups were evaluated retrospectively. The follow-up assessment was conducted on the phase II rehabilitation program. The assessed variables were pain, crepitus, and the Indonesian-validated Kujala score. Results: No significant differences in pain and crepitus were found between both groups. There were significant differences in the Kujala score between both groups (P < .001). The peroneus longus group reported an averagely higher score than the hamstring group. Conclusion: Single bundle ACL reconstruction using peroneus longus tendon autograft produces less patellofemoral symptoms and functional limitation than using hamstring tendon autograft.

scholarly journals Functional Outcome of Arthroscopic Reconstruction of Single Bundle Anterior Cruciate Ligament with 5 Strand Hamstring Autograft

2020 ◽  
Vol 7 (1) ◽  
pp. 78-85
Author(s):  
Nitin Wagh ◽  
Brijbhushan Mahajan ◽  
Bhalchandra Prabhakar Bhalerao ◽  
Nitish Agrawal ◽  
Nimesh Nebhani ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Hamstring Autograft ◽  
Arthroscopic Reconstruction ◽  
Anterior Cruciate

Lateral location of the tibial tunnel increases lateral meniscal extrusion after anatomical single-bundle anterior cruciate ligament reconstruction

2019 ◽  
Vol 4 (6) ◽  
pp. 285-289
Author(s):  
Takeshi Oshima ◽  
Samuel Grasso ◽  
Aaron Beach ◽  
Brett Fritsch ◽  
David A Parker
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Case Series ◽  
Single Bundle ◽  
Characteristic Analysis ◽  
Meniscal Extrusion ◽  
Level Of Evidence ◽  
Anterior Cruciate

IntroductionThe tibial footprint of the anterior cruciate ligament (ACL) overlaps with the anterior lateral meniscal root (ALMR), and there is a possibility that an anatomical tibial tunnel reaming might damage the attachment of ALMR. The aim of this study was to investigate the relationship between tibial tunnel location and lateral meniscal extrusion (LME) after anatomical single-bundle ACL reconstruction.MethodsA prospectively collected database and associated intraoperative findings for 153 patients undergoing primary anatomical ACL reconstruction between October 2014 and July 2016 were investigated. Those cases with no meniscal injury seen at surgery and meeting the criteria (52/153) were included. Tibial plateau length (TPL), width (TPW), tibial tunnel location and LME were evaluated from postoperative high-resolution MRI. The location of the centre of the tibial tunnel was evaluated by the position relative to the medial tibial eminence with two measures, the medial–lateral distance (MLD) and anterior–posterior distance. These measures were expressed as a percentage of the TPW and TPL, respectively. The LME was also expressed as a percentage of TPW and correlated with tibial tunnel location.ResultsThere was a positive correlation between percentage of LME (%LME) and percentage of MLD (%MLD) (r=0.478; p<0.001). Applying receiver operating characteristic analysis, we determined that a cut-off value of 4 %MLD was significant. The mean percentage of LME was 1.20 for >4 %MLD, compared with 0.17 for ≤4 %MLD (p<0.001). No significant correlation was found between %LME and clinical outcomes at 1-year follow-up.ConclusionLateral location of the tibial tunnel increases the rate of LME after single-bundle ACL reconstruction.Level of evidenceLevel IV, Case series.

scholarly journals Presoaking of Hamstring Autografts in Vancomycin Decreases the Occurrence of Infection Following Primary Anterior Cruciate Ligament Reconstruction

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987103 ◽  
Author(s):  
David Figueroa ◽  
Francisco Figueroa ◽  
Rafael Calvo ◽  
Mario Lopez ◽  
Ignacio Goñi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Septic Arthritis ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Fisher Exact Test ◽  
Hamstring Autograft ◽  
Level Of Evidence ◽  
Exact Test ◽  
Anterior Cruciate ◽  
Primary Acl Reconstruction

Background: Postoperative septic arthritis is an uncommon but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with vancomycin to decrease this risk. Purpose: To compare the rate of septic arthritis in primary hamstring autograft ACL reconstruction with and without vancomycin-presoaked grafts. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive periods were studied, inclusive of April 2013 through October 2015 (pre-vancomycin protocol) and November 2015 through May 2018 (vancomycin protocol). A total of 490 patients were included in the study: 230 in the pre-vancomycin protocol and 260 in the vancomycin protocol. All patients who underwent a primary hamstring autograft ACL reconstruction by 2 senior surgeons during the periods studied were included. The final outcome studied was occurrence of highly probable postoperative septic arthritis in both groups. Diagnosis of probable septic arthritis was made by clinical diagnosis as well as cytological analysis of joint aspiration (cell count >50,000/μL and >90% neutrophils). Statistical analysis was performed with the Fisher exact test. Significance was set at P < .05. Results: Four cases of probable postoperative septic arthritis were noted in the pre-vancomycin protocol (1.7%; 2 cases per surgeon), while no cases of septic arthritis were noted in the vancomycin protocol during the study period ( P < .05). Diagnosis was made at a mean 21.7 days (range, 16-25 days). Staphylococcus epidermidis was isolated in 2 cases, and in the other 2 cases, no organism was isolated. Conclusion: Presoaking of hamstring autografts in vancomycin for primary ACL reconstruction prevented the occurrence of postoperative septic arthritis during the study period as compared with no soaking of the grafts.

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