Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques

Temponi, Eduardo Frois; Costa, Luís Henrique Grassi Marques da; Soares, Luiz Fernando Machado; Carvalho, Lúcio Honório de

doi:10.1016/j.rbo.2017.09.008

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Original Article • Rev. bras. ortop. 54 (01) • Jan-Feb 2019 • https://doi.org/10.1016/j.rbo.2017.09.008 copy

Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques^* * Work developed at the Hospital Madre Teresa, Belo Horizonte, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the contamination rate of hamstring tendon autografts by comparing two different techniques, and to verify whether intraoperative contamination is associated with the development of clinical infection in patients submitted to reconstruction of the anterior cruciate ligament (ACL).

Methods:

A total of 110 hamstring tendon autograft ACL reconstructions were performed and divided into two groups: 1-hamstring tendon retraction technique; and 2 - technique maintaining the tibial insertion of the hamstring tendon. During the preparation, two graft fragments were sent for culturing; the harvesting time, the preparation time, and the total surgery time were measured. Twenty-four hours after the surgery, the C-reactive protein was assayed. The clinical outpatient follow-up was performed up to 180 days postoperatively.

Results:

Although there were two postoperative infections, there was no graft contamination or difference between the groups in relation to the graft preparation time and to the 24-hour postoperative C-reactive protein assessment. The classic technique presented a longer graft harvesting time (p = 0.038), and there was no statistical difference between the 2 groups regarding the degree of contamination and consequent clinical infection, although 2 patients in group 2 presented with infection, with negative perioperative cultures.

Conclusion:

Based on the results obtained, there was no association between graft contamination and the time or technique of its preparation. In addition, there was also no association between intraoperative contamination and the development of clinical infection, nor was there any sign of an association between the early alteration of Creactive protein and the onset of infection.

Keywords:
flexor graft; anterior cruciate ligament reconstruction; infection; septic arthritis

Variable	Category	Group 1	Group 2	Total	p-value	Test
Gender	Male	30	64	94	0.756	Chi-squared
	Female	6	10	16
	Total	36	74	110
Lesion side	Left	22	38	60	0.572	Fisher
	Right	14	36	50
	Total	36	74	110
Associated lesion	No lesion	20	36	56	0.446	Chi-squared
	With lesion	16	38	54
	Total	36	74	110
Septic arthritis	Negative	34	70	104	0.488	Chi-squared
(clinical infection)	Positive	0	2	2
	Total	34	72	106

	Comorbidity	Group 1	Group 2	Total	p-value	Test
No comorbidities	Yes	24	46	24	ns	Chi-squared
	No	12	28	12
Smoking	Yes	4	12	4	ns	Chi-squared
	No	32	62	32
Hypertension	Yes	2	8	2	ns	Chi-squared
	No	34	66	34
Asthma	Yes	0	2	0	ns	Chi-squared
	No	36	72	36
Diabetes	Yes	2	2	2	ns	Chi-squared
	No	34	72	34
Hypothyroidism	Yes	0	2	0	ns	Chi-squared
	No	36	72	36
Depression	Yes	4	2	4	ns	Chi-squared
	No	32	72	32

Variable	Used technique	Average	Standard deviation	p-value
Graft harvesting time (min)	Group 1–classical technique	10.1	2.7	p< 0.05
Graft harvesting time (min)	Group 2–technique maintaining insertion	8.3	2.8
24-hour C-reactive protein (mg/dL)	Group 1–classical technique	8.6	5.0	ns
24-hour C-reactive protein (mg/dL)	Group 2–technique maintaining insertion	13.5	11.0
Variable	Used technique	Median	Standard deviation	p-value
Age (years old)	Group 1–classical technique	30.50	8.8	ns
Age (years old)	Group 2–technique maintaining insertion	30.00	8.3
Weight (kg)	Group 1–classical technique	84.00	10.6	ns
Weight (kg)	Group 2–technique maintaining insertion	78.00	14.9	ns
Height (cm)	Group 1–classical technique	173.00	10.6	ns
Height (cm)	Group 2–technique maintaining insertion	176.00	6.9	ns
Graft preparation time (minutes)	Group 1–classical technique	24.50	6.0	ns
Graft preparation time (minutes)	Group 2–technique maintaining insertion	27.00	7.0	ns
Total surgery time (minutes)	Group 1–classical technique	52.00	8.7	ns
Total surgery time (minutes)	Group 2–technique maintaining insertion	52.00	7.9	ns

Author	Total N	Positive cultures/%	Organism (n)	Clinical infections/%
Hantes et al., 2008¹¹11 Hantes ME, Basdekis GK, Varitimidis SE, Giotikas D, Petinaki E, Malizos KN. Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am 2008;90(4):760-4	30	4/13%	Staphylococcus aureus (2)	0
			Acinetobacter (1)
			Staphylococcus epidermidis (1)
Gavriilidis et al., 2009²³23 Gavriilidis I, Pakos EE, Wipfler B, Benetos IS, Paessler HH. Intraoperative hamstring tendon graft contamination in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2009;17(9):1043-7	89	9/10%	S. epidermidis (2)	0
			Enterococcus (2)
			Staphylococcus capitis (1)
			Peptostreptococcus (1)
			Corynebacterium (1)
			Bacillus cereus (1)
			Propionibacterium granulosum (1)
Plante et al., 2013²⁴24 Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA. Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013;21(3):696-701	30	7/23%	S. aureus (1)	0
			Streptococcus viridians (1)
			Corynebacterium (1)
			Staphylococcus no aureus (1)
			Lactobacillus (1)
			Propionibacterium acnes (1)
			Escherichia coli (1)
Nakayama et al., 2012²¹21 Nakayama H, Yagi M, Yoshiya S, Takesue Y. Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2012;28(5):667-71	50	1/2%	Bacillus sp. (1)	1/2%
Barbier et al., 2015²⁵25 Barbier O, Danis J, Versier G, Ollat D.When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy. Knee 2015;22(5):380-3	25	3/12%	Staphylococcus hominis (1)	0
			Staphylococcus capitis (1)
			Candida parapsilosis (1)
Bradan et al., 2016²²22 Badran MA, Moemen DM. Hamstring graft bacterial contamination during anterior cruciate ligament reconstruction: clinical and microbiological study. Int Orthop 2016;40(9):1899-903	60	10/16.7%	Staphylococcus epidermidis (4)	0
			Staphylococcus aureus (2)
			Acinetobacter (2)
			Bacillus spp. (1)
			Citrobacter spp. (1)
(present study)	110	0/0	No growth	2/1.8%

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence
Eduardo Frois Temponi, Hospital Madre Teresa, Belo Horizonte, MG, Brasil (e-mail: dufrois@hotmail.com).

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Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques* * Work developed at the Hospital Madre Teresa, Belo Horizonte, MG, Brazil.

Abstract

Objective:

Methods:

Results:

Conclusion:

Hamstring Tendon Autograft Contamination in Anterior Cruciate Ligament Reconstruction: Comparison between two Harvesting Techniques^* * Work developed at the Hospital Madre Teresa, Belo Horizonte, MG, Brazil.