Lower incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction with qua
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Lower incidence of post‑operative septic arthritis following revision anterior cruciate ligament reconstruction with quadriceps tendon compared to hamstring tendons Philipp Schuster1,2 · Michael Schlumberger1,3 · Philipp Mayer1 · Vasileios A. Raoulis4,5 · Damian Oremek1 · Martin Eichinger1,3 · Jörg Richter1 Received: 19 August 2019 / Accepted: 22 January 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To determine and compare the incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with autologous quadriceps tendon (with patellar bone block) compared to autologous hamstring tendons (semitendinosus and gracilis). Methods A total of 1638 isolated R-ACLR with either autologous hamstring tendons (n = 1004, 61.3%) or quadriceps tendon (n = 634; 38.7%) were performed between 2004 and 2017 and were retrospectively analysed with regard to the occurrence of post-operative septic arthritis. The technique of R-ACLR did not significantly change during the years of the study. All patients received pre-op i.v.antibiotics, but no presoaking of the grafts in vancomycin was performed in the years of the study. The individual decision of graft choice was based on graft availability, tunnel position and the presence of tunnel widening. Generally, hamstring tendons were preferred. There were no clinically relevant differences between the groups regarding gender or age. Routine follow-up examination was performed 6 weeks after the index operation (follow-up rate 96.5%), and patients unsuspicious for septic arthritis at that time were classified as non-infected. Results Fourteen patients with septic arthritis were identified, resulting in an overall incidence of 0.85%. There was one patient with septic arthritis in the quadriceps tendon group (incidence: 0.16%) and 13 patients in the hamstring tendons group (incidence: 1.29%), respectively. The difference was significant (p = 0.013). Conclusion In this series, the incidence of post-operative septic arthritis after R-ACLR was lower when quadriceps tendon graft was used compared to hamstring tendon grafts. Level of evidence III. Keywords ACL · Anterior cruciate ligament · Anterior cruciate ligament reconstruction · Graft · Infection · Septic arthritis · Complication · Hamstrings · Quadriceps · Quadriceps · Tendon · Revision
Introduction Investigation performed at the Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Germany. * Philipp Schuster [email protected] 1
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Centre of Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt‑Lindemann‑Weg 10, 71706 Markgroeningen, Germany Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Nuremberg, Germany
Septic arthritis following anterior cruciate ligament reconstruction (ACLR) is generally rare, but dramatic cases and generally inferior results with regard to functional and 3
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