Robert H Brophy1, Rick W Wright2, Laura J Huston3, Samuel K Nwosu4, Kurt P Spindler5. 1. Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St. Louis, MO 63110. 3. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, MCE, South Tower, Suite 4200, Nashville, TN 37232. 4. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Suite 11000, Nashville, TN 37203. 5. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 5555 Transportation Boulevard, Garfield Heights, OH 44125.
Abstract
BACKGROUND: Although rare, infection can be devastating after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to test the association between infection after ACL reconstruction and potential risk factors such as age, body mass index (BMI), smoking, diabetes, and graft choice. METHODS: We reviewed the Multicenter Orthopaedic Outcomes Network (MOON) cohort from 2002 to 2005 to identify patients with a postoperative infection. The age, BMI, smoking status, history of diabetes, and graft choice were recorded for each patient. A multivariable regression analysis was constructed to examine which baseline risk factors were independently associated with postoperative infection after ACL reconstruction requiring surgical intervention. RESULTS: There were 2198 eligible patients in the cohort, with seventeen (0.8%) reporting a postoperative infection. Diabetes was found to be a significant risk factor for infection (odds ratio [OR] = 18.8; 95% confidence interval [CI] = 3.8 to 94.0; p < 0.001). Compared with bone-tendon-bone autograft, both hamstring autograft and other grafts (e.g., the majority of allografts, with some that were both autograft and allograft) also increased the risk of infection (OR = 4.6 [95% CI = 1.2 to 17.9; p = 0.026] for hamstrings and 4.3 [95% CI = 1.0 to 18.1; p = 0.047] for other grafts). Although the OR for infection in smokers was 2.5, this finding did not reach significance. CONCLUSIONS: Patients with diabetes undergoing ACL reconstruction have a significantly elevated risk of postoperative infection (18.8-times higher odds) compared with that for patients without diabetes. Use of bone-tendon-bone autograft is associated with a lower risk of infection after ACL reconstruction.
BACKGROUND: Although rare, infection can be devastating after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to test the association between infection after ACL reconstruction and potential risk factors such as age, body mass index (BMI), smoking, diabetes, and graft choice. METHODS: We reviewed the Multicenter Orthopaedic Outcomes Network (MOON) cohort from 2002 to 2005 to identify patients with a postoperative infection. The age, BMI, smoking status, history of diabetes, and graft choice were recorded for each patient. A multivariable regression analysis was constructed to examine which baseline risk factors were independently associated with postoperative infection after ACL reconstruction requiring surgical intervention. RESULTS: There were 2198 eligible patients in the cohort, with seventeen (0.8%) reporting a postoperative infection. Diabetes was found to be a significant risk factor for infection (odds ratio [OR] = 18.8; 95% confidence interval [CI] = 3.8 to 94.0; p < 0.001). Compared with bone-tendon-bone autograft, both hamstring autograft and other grafts (e.g., the majority of allografts, with some that were both autograft and allograft) also increased the risk of infection (OR = 4.6 [95% CI = 1.2 to 17.9; p = 0.026] for hamstrings and 4.3 [95% CI = 1.0 to 18.1; p = 0.047] for other grafts). Although the OR for infection in smokers was 2.5, this finding did not reach significance. CONCLUSIONS:Patients with diabetes undergoing ACL reconstruction have a significantly elevated risk of postoperative infection (18.8-times higher odds) compared with that for patients without diabetes. Use of bone-tendon-bone autograft is associated with a lower risk of infection after ACL reconstruction.
Authors: Rick W Wright; Warren R Dunn; Annunziato Amendola; Jack T Andrish; John Bergfeld; Christopher C Kaeding; Robert G Marx; Eric C McCarty; Richard D Parker; Michelle Wolcott; Brian R Wolf; Kurt P Spindler Journal: Am J Sports Med Date: 2007-04-23 Impact factor: 6.202
Authors: Kurt P Spindler; Todd A Warren; J Claiborne Callison; Michelle Secic; Sheryl B Fleisch; Rick W Wright Journal: J Bone Joint Surg Am Date: 2005-08 Impact factor: 5.284
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Authors: Laurie M Katz; Todd C Battaglia; Paul Patino; William Reichmann; David J Hunter; John C Richmond Journal: Arthroscopy Date: 2008-09-13 Impact factor: 4.772
Authors: Joseph U Barker; Mark C Drakos; Travis G Maak; Russell F Warren; Riley J Williams; Answorth A Allen Journal: Am J Sports Med Date: 2009-11-13 Impact factor: 6.202
Authors: Ahmad M Al-Bashaireh; Linda G Haddad; Michael Weaver; Debra Lynch Kelly; Xing Chengguo; Saunjoo Yoon Journal: J Environ Public Health Date: 2018-07-11
Authors: Daniel Pérez-Prieto; María E Portillo; Raúl Torres-Claramunt; Xavier Pelfort; Pedro Hinarejos; Joan C Monllau Journal: Knee Surg Sports Traumatol Arthrosc Date: 2017-10-07 Impact factor: 4.342
Authors: Raúl Torres-Claramunt; Pablo Gelber; Xavier Pelfort; Pedro Hinarejos; Joan Leal-Blanquet; Daniel Pérez-Prieto; Joan C Monllau Journal: Int Orthop Date: 2015-08-04 Impact factor: 3.075
Authors: Robert H Brophy; Laura J Huston; Rick W Wright; Samuel K Nwosu; Christopher C Kaeding; Richard D Parker; Jack T Andrish; Robert G Marx; Eric C McCarty; Annunziato Amendola; Brian R Wolf; Warren R Dunn; Michelle L Wolcott; Kurt P Spindler Journal: Med Sci Sports Exerc Date: 2016-06 Impact factor: 5.411
Authors: Hamidreza Yazdi; Alireza Yousof Gomrokchi; Ara Nazarian; Aron Lechtig; Philip Hanna; Mohammad Ghorbanhoseini Journal: Arch Bone Jt Surg Date: 2019-01
Authors: Robert H Brophy; Rick W Wright; Laura J Huston; Amanda K Haas; Christina R Allen; Allen F Anderson; Daniel E Cooper; Thomas M DeBerardino; Warren R Dunn; Brett Brick A Lantz; Barton Mann; Kurt P Spindler; Michael J Stuart; John P Albright; Annunziato Ned Amendola; Jack T Andrish; Christopher C Annunziata; Robert A Arciero; Bernard R Bach; Champ L Baker; Arthur R Bartolozzi; Keith M Baumgarten; Jeffery R Bechler; Jeffrey H Berg; Geoffrey A Bernas; Stephen F Brockmeier; Charles A Bush-Joseph; Jay Brad V Butler; John D Campbell; James L Carey; James E Carpenter; Brian J Cole; Jonathan M Cooper; Charles L Cox; Robert Alexander Creighton; Diane L Dahm; Tal S David; David C Flanigan; Robert W Frederick; Theodore J Ganley; Elizabeth A Garofoli; Charles J Gatt; Steven R Gecha; James Robert Giffin; Sharon L Hame; Jo A Hannafin; Christopher D Harner; Norman Lindsay Harris; Keith S Hechtman; Elliott B Hershman; Rudolf G Hoellrich; Timothy M Hosea; David C Johnson; Timothy S Johnson; Morgan H Jones; Christopher C Kaeding; Ganesh V Kamath; Thomas E Klootwyk; Bruce A Levy; Chunbong Benjamin Ma; G Peter Maiers; Robert G Marx; Matthew J Matava; Gregory M Mathien; David R McAllister; Eric C McCarty; Robert G McCormack; Bruce S Miller; Carl W Nissen; Daniel F O'Neill; Brett D Owens; Richard D Parker; Mark L Purnell; Arun J Ramappa; Michael A Rauh; Arthur C Rettig; Jon K Sekiya; Kevin G Shea; Orrin H Sherman; Xulei Li; James R Slauterbeck; Matthew V Smith; Jeffrey T Spang; Ltc Steven J Svoboda; Timothy N Taft; Joachim J Tenuta; Edwin M Tingstad; Armando F Vidal; Darius G Viskontas; Richard A White; James S Williams; Michelle L Wolcott; Brian R Wolf; James J York Journal: J Orthop Res Date: 2020-10-19 Impact factor: 3.494