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    Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction

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    Authors
    Plante, Matthew J.
    Li, Xinning
    Scully, Gail
    Brown, Michael A.
    Busconi, Brian D.
    DeAngelis, Nicola A.
    UMass Chan Affiliations
    Department of Orthopedics and Physical Rehabilitation
    Document Type
    Journal Article
    Publication Date
    2012-05-15
    Keywords
    Orthopedic Procedures
    Anterior Cruciate Ligament Reconstruction
    Transplantation, Autologous
    Decontamination
    Sterilization
    Orthopedics
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1007/s00167-012-2049-8
    Abstract
    PURPOSE: Inadvertent contamination of the hamstring autograft during ACL reconstruction is infrequent, but can result in significant complications. The purpose of this study is to evaluate bacterial contamination of hamstring autografts dropped onto the operating room floor and methods of graft decontamination. METHODS: Hamstring tendons were harvested from patients. Excess tendon not used in the ACL procedure was divided into 6 segments. Segments were assigned to 6 groups (A through F, N = 30 in each group): group A: uncontaminated graft immediately postharvest (control), group B: graft dropped onto the floor (5 s), group C: graft dropped onto the floor (15 s). grafts in groups D to F were dropped onto floor for 15 s then rinsed with saline (group D), bacitracin solution (group E) or chlorhexidine 4 % solution (group F) for 3 min. All grafts were sent to the microbiology laboratory for anaerobic and aerobic cultures. RESULTS: Cultures were positive in 23 % of graft segments from group A (7/30), 33 % of grafts from group B (10/30), 23 % from group C (7/30), 30 % from group D (9/30) and 3 % from both group E (1/30) and group F (1/30). Sixteen unique organisms were identified, with Staphylococcus aureus as the most common isolate. Grafts rinsed in either bacitracin solution or 4 % chlorhexidine solutions were significantly less likely to be culture positive when compared to control graft segments (p < 0.05). However, there was no significant difference between uncontaminated grafts retrieved in CONCLUSION: This study supports the practice of decontaminating a dropped ACL hamstring autograft using either 4 % chlorhexidine or bacitracin solution. Specimens should be retrieved sterilely and washed for at least 3 min. This study also demonstrates no advantage in retrieval time of less than 5 s as compared to 15 s for uncontaminated graft. Hamstring harvest in ACL reconstruction may result in positive cultures, thus routine soaking of the hamstring autograft in either bacitracin or 4 % chlorhexidine solution is recommended. In addition, dropped hamstring autograft can be effectively sterilized with bacitracin or 4 % chlorhexidine solution. LEVEL OF EVIDENCE: II.
    Source
    Knee Surg Sports Traumatol Arthrosc. 2012 May 15. Link to article on publisher's site
    DOI
    10.1007/s00167-012-2049-8
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42921
    PubMed ID
    22584912
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00167-012-2049-8
    Scopus Count
    Collections
    UMass Chan Faculty and Researcher Publications
    Orthopedics and Physical Rehabilitation Publications

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