RESUMO
BACKGROUND: Several reports of severe infections associated with allograft tissue in knee reconstructive surgery have led many surgeons to consider routine intraoperative culture of allograft tissue before implantation. Thus, the purpose of this study was to determine the prevalence of positive soft tissue allograft cultures in reconstructive knee surgery, and evaluate its association with surgical site infection. METHODS: Retrospective study of 202 patients who underwent knee reconstructive ligament surgeries, including revisions, between January 2013 and July 2017. Intraoperative culture results were obtained and the report of a surgical site infection during follow-up was recorded. Patients without cultures were excluded. A priori power analysis was performed. The association between positive culture results and development of surgical site infection was evaluated using Fisher's Exact test (Pâ¯<â¯0.05). RESULTS: A total of 300 allografts were implanted in 202 patients. Mean average follow-up was 32.9⯱â¯12.5 (range 13 to 57.9) months. Sixteen patients had positive intraoperative allograft cultures (7.9%). The most frequently isolated organism was Bacillus species (six cultures); none of these patients presented with clinical signs of infection. Nine patients developed surgical site infections and were treated with oral antibiotics, and one patient developed septic arthritis that required surgical debridement of the implanted graft; all of these patients had a negative soft tissue allograft culture. No significant association was found between a positive culture and surgical site infection (Pâ¯=â¯0.43). CONCLUSION: There was no apparent association between positive intraoperative irradiated soft tissue allograft cultures and surgical site infection in reconstructive knee surgery.
Assuntos
Tendão do Calcâneo/microbiologia , Tendão do Calcâneo/transplante , Aloenxertos , Cuidados Intraoperatórios , Ligamentos Articulares/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Artrite Infecciosa/etiologia , Bacillus/isolamento & purificação , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/cirurgia , Ligamentos Articulares/lesões , Masculino , Estudos Retrospectivos , Staphylococcus/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologiaRESUMO
The anterolateral structures of the knee have recently garnered considerable interest regarding their role in rotatory knee instability related to anterior cruciate ligament tears. Isolated anterior cruciate ligament reconstruction may not always restore rotatory stability of the knee. In these patients, additional procedures, such as lateral reconstruction or tenodesis, may be indicated. The anatomy of the anterolateral structures of the knee has been well described. Histologic and anatomic studies have reported conflicting findings regarding the presence of a discrete ligament. The biomechanical role of the anterolateral capsule in restraining internal tibial rotation has been described as negligible. The existing body of research on the anterolateral knee structures provides insight into the composition of the anterolateral complex of the knee.