title: The incidence of and clinical approach to positive allograft cultures in anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To define the incidence of positive allograft cultures in anterior cruciate ligament (ACL) reconstruction and to determine a clinical approach to a positive test.
  
  
  METHODS
  Retrospective chart review, cohort series.
  
  
  METHODS
  Urban academic hospital.
  
  
  METHODS
  All patients who underwent anterior cruciate ligament reconstruction using allograft between January 2003 and December 2008. One hundred fifteen patients met the inclusion criteria.
  
  
  METHODS
  Culture of allograft before surgical implantation.
  
  
  METHODS
  Positive allograft culture.
  
  
  RESULTS
  Positive allograft cultures were obtained in 3 of 115 grafts (2.6%). Two cultures grew coagulase-negative Staphylococcus and 1 grew Escherichia coli, both from the broth only.
  
  
  CONCLUSIONS
  Positive cultures in ACL allografts have a reported incidence of 5.7% to 13.25%. Our current series shows an incidence of 2.6%. No patients who had a culture-positive allograft developed a clinical infection postoperatively. Routine preimplantation culture of soft tissue allografts cannot be recommended given the low incidence of positive culture and lack of correlation with clinical infection. In the presence of a positive preimplantation allograft culture without signs of clinical infection, our series and the 4 other published series in the literature demonstrate that antibiotic treatment is not indicated. In contrast, signs and symptoms of septic arthritis should be aggressively treated with irrigation, debridement, and intravenous antibiotics.
authors.affiliation: Department of Orthopaedics and Sports Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA. fowler@temple.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Fowler
authors.forename: Allan L
authors.initials: AL
authors.lastname: Truant
authors.forename: J Milo
authors.initials: JM
authors.lastname: Sewards
mesh_terms: D016118:Anterior Cruciate Ligament / Q000382:microbiology* / Q000637:transplantation; D059549:Anterior Cruciate Ligament Reconstruction; D019072:Antibiotic Prophylaxis; D001170:Arthritis, Infectious / Q000628:therapy; D001424:Bacterial Infections / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D014184:Transplantation, Homologous