Abstract
BackgroundNovel microbial detection technologies have revealed that chronic bacterial biofilms, which are recalcitrant to antibiotic treatment, are common in failed orthopedic procedures.QuestionsAre bacteria present on failed anterior cruciate ligament (ACL) reconstructions? Is there a difference in the presence or nature of bacteria in failed ACL reconstructions relative to a control set of healthy ACL’s?MethodsWe used a case–control study design, where we analyzed the bacterial composition of 10 failed ACL reconstructions and compared it to 10 native ACL’s harvested during total knee arthroplasty. The IBIS Universal Biosensor was used to determine the nature of bacteria on ACL specimens, and fluorescent in situ hybridization (FISH) was used to visualize bacteria in a subset of cases.ResultsBacteria are present in failed ACL reconstructions. Bacteria are present in ACL’s harvested during total knee arthroplasty, but the nature of the species differs significantly between experimental and control sets. Twelve genera were detected in the experimental set (in both allografts and autografts), and in four samples multiple species were detected. In contrast, the control group was characterized by presence of Propionibacterium acnes.ConclusionsWe demonstrate the presence of bacteria on failed ACLs surgeries, and open the door to investigate whether and how bacteria and the associated immune responses could possibly contribute to graft failure.Clinical relevanceIf microbial pathogens can be linked to failed grafts, it could provide: (1) markers for early diagnosis of abnormal healing in ACL surgeries, and (2) targets for early treatment to prevent additional reconstruction surgeries.
Highlights
Novel microbial detection technologies have revealed that chronic bacterial biofilms, which are recalcitrant to antibiotic treatment, are common in failed orthopedic procedures.Questions: Are bacteria present on failed anterior cruciate ligament (ACL) reconstructions? Is there a difference in the presence or nature of bacteria in failed ACL reconstructions relative to a control set of healthy ACL’s?
We demonstrate the presence of bacteria on failed ACLs surgeries, and open the door to investigate whether and how bacteria and the associated immune responses could possibly contribute to graft failure
Clinical relevance: If microbial pathogens can be linked to failed grafts, it could provide: (1) markers for early diagnosis of abnormal healing in ACL surgeries, and (2) targets for early treatment to prevent additional reconstruction surgeries
Summary
Novel microbial detection technologies have revealed that chronic bacterial biofilms, which are recalcitrant to antibiotic treatment, are common in failed orthopedic procedures.Questions: Are bacteria present on failed anterior cruciate ligament (ACL) reconstructions? Is there a difference in the presence or nature of bacteria in failed ACL reconstructions relative to a control set of healthy ACL’s?. Questions: Are bacteria present on failed anterior cruciate ligament (ACL) reconstructions? Revision anterior cruciate ligament (ACL) surgery is a challenging problem for orthopaedic surgeons and their patients as long-term outcomes of revision ACL surgery have been shown to be inferior to primary ACL reconstructions (Wright et al 2012). Failed primary ACL reconstructions can be attributed to traumatic rupture of the graft, technical error, failure of the graft to incorporate, biologic factors, or a combination of the above (MARS Group et al 2010). A combination of mechanical and biologic factors can cause tunnel lysis or enlargement which leads to long-term instability of the graft (Wilson et al 2004).
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