Resumen de Etiology, prevention and treatment of infections after anterior cruciate ligament reconstruction
Infections after anterior cruciate ligament reconstruction (ACL-R) are complications with an incidence between 0,5% and 1,5% and can cause serious knee joint damage if a correct treatment is not applied. During last decade several studies about arthroscopic debridement efficacy and outcomes have been published. However, literature about the origin and prevention of ACL-R infections is scarce same as its antibiotic treatment.
The present thesis is a compendium of three publications about the etiology, the prevention and the treatment of infections after ACL-R. The purposes are: to evaluate the ACL graft contamination as a source of infection; to evaluate the effectiveness of a 5mg/dl vancomycin solution to eradicate contamination and thus reduce infection’s rate; and finally, to evaluate the combination of levofloxacin and rifampicin as the optimal antibiotic treatment for staphylococcal infections.
A contamination rate of 14% was observed during ACL graft harvesting and preparation, most of it due to staphylococci (71%). The soaking in a 5mg/dl vancomycin solution completely eradicates contamination. In clinical practice the presoaking of ACL graft in the vancomycin solution reduces infection rate from 1,8% to 0%. Finally the combination of oral levofloxacin and rifampicin (along with arthroscopic debridement) for a period of 6 weeks is an effective treatment for staphylococcal infections.
The conclusions of the present thesis and its publications compendium are: 1) The ACL graft harvesting and preparation is a source of contamination that can lead to infection. 2) The vancomycin solution of 5mg/dl completely eradicates the aforementioned contamination and reduces ACL-R infection rate to 0%. 3) The combination of levofloxacin and rifampicin after arthroscopic debridement is the optimal antibiotic schedule for staphylococcal ACL-R infections.
