Effect of autograph used in anterior cruciate ligament reconstruction surgery on postoperative infection rate
Abstract
Purpose: The aim of this study was to investigate effect of autograft selection on the infection risk following arthroscopic anterior cruciate ligament (ACL) reconstruction surgery.
Materials and Methods: Between June 2004 and October 2018, 840 consecutive patients who underwent primary arthroscopic ACL reconstruction with either a hamstring tendon autograft or a bone patellar tendon bone (BTB) autograft were reviewed retrospectively. Patients were assigned into two groups based on the type of graft used: First group was bone-patellar tendon-bone (BTB) autograft group (n=354) and second group was hamstring tendon autograft group (n=466). These two groups were compared statistically in terms of demographic characteristic and postoperative infection status. After primary ACL reconstruction, local and systemic clinical findings of infection (knee effusion, systemic fever, nausea, weakness) supported by laboratory findings (C-Reactive Protein (CRP), Erytrocyt Sedimentation Rate (ESR)) were defined as infection.
Results: There was a statistically increased risk of infection with hamstring tendon autograft compared to BTB autograft. While the infection rate in the first group (BTB) was 0.3 % (n=1), the infection rate in the second group (Hamstring tendon) was 4.7 % (n=22).
Conclusion: In this study, a higher infection rate was found in primary ACL cases treated with hamstring tendon autograft compared to those using BTB autografts. Orthopedic surgeons should be aware of the increased risk of infection when hamstring autograft is used in ACL reconstruction surgery and should prefer BTB autograft over hamstring autograft in appropriate indication.
Kaynakça
- Referans 1- Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC. Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2010;92(14):2402-2408.
- Referans 2- Laxdal G., Kartus J., Hansson L., Heidvall M., Ejerhed L., Karlsson J. A prospective randomized comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction. Arthroscopy 2005 Jan; 21: pp. 34-42.
- Referans 3- Liden M., Ejerhed L., Sernert N., Laxdal G., Kartus J. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction. A prospective, randomized study with a 7-year follow-up. Am J Sports Med 2007 May; 35: pp. 740-748.
- Referans 4- Gifstad T., Sole A., Strand T., Uppheim G., Grontvedt T., Drogset J.O. Long-term follow-up of patellar tendon grafts or hamstring tendon grafts in endoscopic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2013 Mar; 21: pp. 576-583.
- Referans 5- Goldblatt J.P., Fitzsimmons S.E., Balk E., and Richmond J.C. Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 2005 Jul; 21: pp. 791-803.
- Referans 6- Mae T., Shino K., Nakagawa S., Take Y., Hiramatsu K., Yoshikawa H. et al. Second-look arthroscopy after anatomic anterior cruciate ligament reconstruction: Bone-patellar tendon-bone versus hamstring tendon graft. Journal of Orthopedic Science. 2018;doi: 10.1016 (in press)
- Referans 7- Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F. Anterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial. J Bone Joint Surg Am 2004; 86-A(10):2143–2155.
- Referans 8- Feller JA, Webster KE. A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 2003;31(4):564–573.
- Referans 9- Aune AK, Holm I, Risberg MA, Jensen HK, Steen H. Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. Am J Sports Med 2001:29:722–728.
- Referans 10- Matsumoto A, Yoshiya S, Muratsu H, Yagi M, Iwasaki Y, Kurosaka M et al. A comparison of bone-patellar tendon-bone and bone-hamstring tendon-bone autografts for anterior cruciate ligament reconstruction. Am J Sports Med 2006;34(2):213–219.
