Moriarty Peter, Kayani Babar, Wallace Charles, Chang Justin, Plastow Ricci, Haddad Fares S
University College Hospital, London, UK.
Institute of Sports, London, UK.
Bone Jt Open. 2021 Jan 22;2(1):66-71. doi: 10.1302/2633-1462.21.BJO-2020-0181.R1. eCollection 2021 Jan.
Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of hamstring grafts influences infection rates following ACLR. We set out to examine this in our study accordingly.
This retrospective study included 2,000 patients (1,156 males and 844 females) who underwent primary ACLR with hamstring autografts between 2007 to 2017. This included 1,063 patients who received pre-soaked saline hamstring grafts for ACLR followed by 937 patients who received pre-soaked gentamicin hamstring grafts for ACLR. All operative procedures were completed by a single surgeon using a standardized surgical technique. Medical notes were reviewed and data relating to the following outcomes recorded: postoperative infection, clinical progress, causative organisms, management received, and outcomes.
Superficial wound infection developed in 14 patients (1.31 %) receiving pre-saline soaked hamstring grafts compared to 13 patients (1.38 %) receiving pre-gentamicin soaked hamstring grafts, and this finding was not statistically significant (p = 0.692). All superficial wound infections were treated with oral antibiotics with no further complications. There were no recorded cases of septic arthritis in patients receiving pre-gentamicin soaked grafts compared to nine patients (0.85%) receiving pre-saline soaked grafts, which was statistically significant (p = 0.004).
Pre-soaking hamstring autographs in gentamicin does not affect superficial infection rates but does reduce deep intra-articular infection rates compared to pre-soaking hamstring grafts in saline alone. These findings suggest that pre-soaking hamstring autografts in gentamicin provides an effective surgical technique for reducing intra-articular infection rates following ACLR.Cite this article: 2021;2(1):66-71.
前交叉韧带重建术（ACLR）后移植物感染可能导致化脓性关节炎，需要多次冲洗和清创手术、分期翻修手术以及长期使用抗生素治疗。据我们所知，此前尚无研究报道庆大霉素预浸泡腘绳肌移植物对ACLR后感染率的影响。因此，我们在本研究中对此进行了探讨。
这项回顾性研究纳入了2007年至2017年间接受腘绳肌自体移植进行初次ACLR的2000例患者（男性1156例，女性844例）。其中1063例患者接受了预浸泡生理盐水的腘绳肌移植物进行ACLR，随后937例患者接受了预浸泡庆大霉素的腘绳肌移植物进行ACLR。所有手术均由同一位外科医生采用标准化手术技术完成。查阅病历并记录以下相关结果的数据：术后感染、临床进展、致病微生物、接受的治疗及结果。
接受预浸泡生理盐水腘绳肌移植物的患者中有14例（1.31%）发生浅表伤口感染，而接受预浸泡庆大霉素腘绳肌移植物的患者中有13例（1.38%）发生浅表伤口感染，这一结果无统计学意义（p = 0.692）。所有浅表伤口感染均采用口服抗生素治疗，无进一步并发症。接受预浸泡庆大霉素移植物的患者中未记录到化脓性关节炎病例，而接受预浸泡生理盐水移植物的患者中有9例（0.85%）发生化脓性关节炎，差异具有统计学意义（p = 0.004）。
与仅用生理盐水预浸泡腘绳肌移植物相比，用庆大霉素预浸泡腘绳肌自体移植物不影响浅表感染率，但可降低关节内深部感染率。这些发现表明，用庆大霉素预浸泡腘绳肌自体移植物为降低ACLR后关节内感染率提供了一种有效的手术技术。引用本文：2021；2(1):66 - 71。
