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Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions

OBJECTIVES: Technical errors, traumatic re-injury, and biologic failure all play a potential role in failure after ACL reconstruction (ACLR). Recent work has demonstrated the frequent presence of biofilms on failed ACLR grafts. Tunnel widening is commonly observed upon presentation for revision ACLR...

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Autores principales: Flanigan, David C., Everhart, Joshua Scott, DiBartola, Alex, Moley, James, Dusane, Devendra, Magnussen, Robert A., Kaeding, Christopher C., Stoodley, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083806/
http://dx.doi.org/10.1177/2325967118S00067
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author Flanigan, David C.
Everhart, Joshua Scott
DiBartola, Alex
Moley, James
Dusane, Devendra
Magnussen, Robert A.
Kaeding, Christopher C.
Stoodley, Paul
author_facet Flanigan, David C.
Everhart, Joshua Scott
DiBartola, Alex
Moley, James
Dusane, Devendra
Magnussen, Robert A.
Kaeding, Christopher C.
Stoodley, Paul
author_sort Flanigan, David C.
collection PubMed
description OBJECTIVES: Technical errors, traumatic re-injury, and biologic failure all play a potential role in failure after ACL reconstruction (ACLR). Recent work has demonstrated the frequent presence of biofilms on failed ACLR grafts. Tunnel widening is commonly observed upon presentation for revision ACLR but the relationship between biofilm presence and tunnel widening is unclear. The purpose of this study is to determine whether tunnel widening is associated with bacterial biofilms in failed ACL reconstructions. METHODS: 34 consecutive revision ACLR cases and 5 primary ACLR controls were included. Tissue biopsies were obtained from tibial, femoral, and intra-articular segments of revision cases and torn native ligament as well as excess hamstring graft after fixation from primary ACLR controls. Clinical cultures as well as PCR for bacterial DNA with a universal primer were obtained on all patients. Fluorescence microscopy was used to visually confirm presence of biofilm. No patients had clinical signs of infection. Tunnel diameters were measured on pre-operative 3-dimensional imaging. RESULTS: Bacterial DNA was present in 87% of cases and 20% of controls. Cultures were only positive (coagulase negative staphyloccous sp.) in one revision case, the widest measured tunnel diameters were in this same case (20.1 mm for the tibial tunnel and 16.9 mm for the femoral tunnel) Bacterial DNA was positively associated with wider femoral tunnels (median 10.6 mm with detectable bacterial DNA, median 7.6 mm without detectable bacterial DNA; p=0.04 Wilcoxon rank-sum). There was a trend toward higher rates of bacterial DNA in tibial tunnels with diameters greater than 12.5 mm (LR chi square p= 0.12). Fluorescence microscopy confirmed presence of staphylococcal biofilms adherent to the soft tissue graft surface (Figure 1) as well as inert fixation material including monofilament suture, braided suture, and PEEK and metal interference screws. CONCLUSION: Bacterial biofilms are commonly encountered on failed ACLR grafts. These biofilms do not cause clinically apparent infection symptoms but are associated with tunnel widening and may contribute to biologic failure.
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spelling pubmed-60838062018-08-14 Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions Flanigan, David C. Everhart, Joshua Scott DiBartola, Alex Moley, James Dusane, Devendra Magnussen, Robert A. Kaeding, Christopher C. Stoodley, Paul Orthop J Sports Med Article OBJECTIVES: Technical errors, traumatic re-injury, and biologic failure all play a potential role in failure after ACL reconstruction (ACLR). Recent work has demonstrated the frequent presence of biofilms on failed ACLR grafts. Tunnel widening is commonly observed upon presentation for revision ACLR but the relationship between biofilm presence and tunnel widening is unclear. The purpose of this study is to determine whether tunnel widening is associated with bacterial biofilms in failed ACL reconstructions. METHODS: 34 consecutive revision ACLR cases and 5 primary ACLR controls were included. Tissue biopsies were obtained from tibial, femoral, and intra-articular segments of revision cases and torn native ligament as well as excess hamstring graft after fixation from primary ACLR controls. Clinical cultures as well as PCR for bacterial DNA with a universal primer were obtained on all patients. Fluorescence microscopy was used to visually confirm presence of biofilm. No patients had clinical signs of infection. Tunnel diameters were measured on pre-operative 3-dimensional imaging. RESULTS: Bacterial DNA was present in 87% of cases and 20% of controls. Cultures were only positive (coagulase negative staphyloccous sp.) in one revision case, the widest measured tunnel diameters were in this same case (20.1 mm for the tibial tunnel and 16.9 mm for the femoral tunnel) Bacterial DNA was positively associated with wider femoral tunnels (median 10.6 mm with detectable bacterial DNA, median 7.6 mm without detectable bacterial DNA; p=0.04 Wilcoxon rank-sum). There was a trend toward higher rates of bacterial DNA in tibial tunnels with diameters greater than 12.5 mm (LR chi square p= 0.12). Fluorescence microscopy confirmed presence of staphylococcal biofilms adherent to the soft tissue graft surface (Figure 1) as well as inert fixation material including monofilament suture, braided suture, and PEEK and metal interference screws. CONCLUSION: Bacterial biofilms are commonly encountered on failed ACLR grafts. These biofilms do not cause clinically apparent infection symptoms but are associated with tunnel widening and may contribute to biologic failure. SAGE Publications 2018-07-27 /pmc/articles/PMC6083806/ http://dx.doi.org/10.1177/2325967118S00067 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Flanigan, David C.
Everhart, Joshua Scott
DiBartola, Alex
Moley, James
Dusane, Devendra
Magnussen, Robert A.
Kaeding, Christopher C.
Stoodley, Paul
Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title_full Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title_fullStr Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title_full_unstemmed Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title_short Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
title_sort bacterial biofilms are associated with tunnel widening in failed acl reconstructions
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083806/
http://dx.doi.org/10.1177/2325967118S00067
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