- Email: [email protected]
Should Preoperative Antibiotics Be Given in Simple Knee Arthroscopy?
ABSTRACTS
Introduction: Following grade III acromioclavicular (AC) joint injury, some patients who are treated nonoperatively will eventually seek surgical management. The purpose of this study was to compare the clinical outcomes in patients who completed non-operative (non-op) therapy to those who failed non-operative therapy and proceeded to AC reconstruction. Methods: This is a level 3, IRB approved study. 38 patients were initially treated non-op for acute grade III AC injuries with physical therapy. Outcomes measures included SF-12 PCS, ASES, QuickDASH, and SANE with a minimum follow-up of two years. Non-op failure occurred when a patient underwent AC reconstruction before final follow-up. Results: 38 patients with a mean age of 38 years (range, 22-79) were included. 28/38 (74%) successfully completed non-op treatment whereas 10/38 (26%) failed after a median of 44 days (range, 6-511) from the initiation of physical therapy. Of the 10 patients who failed, 9 (90%) sought treatment >30 days after the injury. Two of these patients had a subsequent surgery before final follow-up and were therefore not included in outcomes analysis. Follow-up was available for the remaining 7/8 patients (87.5%) who failed non-op treatment and for 22/28 patients (78%) who were successfully treated nonop. Mean follow up was 3.3 years (range, 2.0-5.9). Although there were no significant differences in outcomes scores between groups (Table1; p >0.05), those who sought treatment >30 days after injury demonstrated decreased postoperative SANE scores (p ¼ 0.002) and had 13.8x greater relative risk for failure of non-op treatment. Conclusion: Surgical decision making after acute grade 3 injuries is evolving. Based on our data, we conclude that (1) a trial of non-op treatment as warranted as successful outcomes can be expected even in those that eventually opt for surgery, and (2) oatients who present >30 days after their injury are much less likely to complete nonoperative treatment successfully. Should Preoperative Antibiotics Be Given in Simple Knee Arthroscopy? SS-22 Thursday, April 23 at 2:50 PM RONALD WYATT, M.D., PRESENTING AUTHOR GREGORY MALETIS, M.D. ANDREW AVINS, M.D., M.P.H. Introduction: Previous studies on the efficacy of preoperative antibiotics in preventing infections in patients undergoing knee arthroscopy (KA) have been either poorly designed or underpowered. The purpose of this study was to determine the association between the use of preoperative antibiotics and the risk of postoperative infection following simple KA. Methods: A health care organization’s electronic medical records were used to identify patients who underwent simple KA between 2007 and 2012. Patient demographics, potential infection risk factors, and prophylactic antibiotic administration data were extracted. Simple KA included
e9
debridement, synovectomy, meniscectomy, meniscus repair, and lateral release. Complex knee arthroscopy and arthroscopy for knee sepsis were excluded. Deep infection was defined as a positive synovial fluid culture or gross pus in the knee. Superficial infection was defined as clinical signs of infection localized to the portal sites treated with an antibiotic. Results: Of 44,112 simple knee arthroscopies, 35,518 (80.5%) received preoperative antibiotics and 8604 (19.5%) did not. The two treatment groups were similar with respect to patient demographics and infection risk factors. There were 30 deep infections in the antibiotic group (0.084%) and 11 in the non-antibiotic group (0.13%). There was no significant association between administering preoperative antibiotics and the risk of a deep infection (Risk Ratio (RR) ¼ 0.66, 95% Confidence Interval (CI): 0.33 to 1.32, p¼0.24). There were 156 superficial infections in the antibiotic group (0.44%) and 31 in the non-antibiotic group (0.36%); this difference was also not statistically significant (RR ¼ 1.30, 95% CI: 0.88 to 1.93, p¼0.23). Conclusion: In our large sample, there was no statistically significant association between preoperative antibiotic use and either deep or superficial infection. Any effect of preoperative antibiotic use is likely to be very small and must be balanced against the potential negative consequences, such as allergic reactions, clostridia difficile colitis, development of resistant organisms, and cost. Medial Quadriceps Tendon-Femoral Ligament (MQTFL) Reconstruction for Patellofemoral Instability SS-23 Thursday, April 23 at 2:55 PM BENJAMIN BARDEN, M.D., PRESENTING AUTHOR NICK REED, M.D. CORY EDGAR, M.D. JOHN FULKERSON, M.D. Introduction: The primary goal of this study was to provide minimum 2 year follow up patient-centered outcomes and the incidence of recurrent instability at an average of 36 months after MQTFL reconstruction. Methods: We identified all of our skeletally mature patients who underwent MQTFL reconstruction before March 2013 for recurrent lateral patellar dislocation refractory to non-operative treatment modalities. The MQTFL was reconstructed utilizing our previously published surgical technique (ArthroscopyTechniques.com) with anatomic bony graft fixation on the femur and softtissue fixation at the distal medial quadriceps tendon insertion. A retrospective chart review was conducted followed by patient examination when possible and a standardized patient questionnaire administered to all patients, focusing on the 2 year minimum follow-up cohort incidence of recurrent instability, patient satisfaction, and activity level. Results: Forty-six (46) knees in 45 patients, average age 19.5 years, underwent outpatient MQTFL reconstruction by the senior author. Twenty-nine (29) knees in 28
Introduction: Following grade III acromioclavicular (AC) joint injury, some patients who are treated nonoperatively will eventually seek surgical management. The purpose of this study was to compare the clinical outcomes in patients who completed non-operative (non-op) therapy to those who failed non-operative therapy and proceeded to AC reconstruction. Methods: This is a level 3, IRB approved study. 38 patients were initially treated non-op for acute grade III AC injuries with physical therapy. Outcomes measures included SF-12 PCS, ASES, QuickDASH, and SANE with a minimum follow-up of two years. Non-op failure occurred when a patient underwent AC reconstruction before final follow-up. Results: 38 patients with a mean age of 38 years (range, 22-79) were included. 28/38 (74%) successfully completed non-op treatment whereas 10/38 (26%) failed after a median of 44 days (range, 6-511) from the initiation of physical therapy. Of the 10 patients who failed, 9 (90%) sought treatment >30 days after the injury. Two of these patients had a subsequent surgery before final follow-up and were therefore not included in outcomes analysis. Follow-up was available for the remaining 7/8 patients (87.5%) who failed non-op treatment and for 22/28 patients (78%) who were successfully treated nonop. Mean follow up was 3.3 years (range, 2.0-5.9). Although there were no significant differences in outcomes scores between groups (Table1; p >0.05), those who sought treatment >30 days after injury demonstrated decreased postoperative SANE scores (p ¼ 0.002) and had 13.8x greater relative risk for failure of non-op treatment. Conclusion: Surgical decision making after acute grade 3 injuries is evolving. Based on our data, we conclude that (1) a trial of non-op treatment as warranted as successful outcomes can be expected even in those that eventually opt for surgery, and (2) oatients who present >30 days after their injury are much less likely to complete nonoperative treatment successfully. Should Preoperative Antibiotics Be Given in Simple Knee Arthroscopy? SS-22 Thursday, April 23 at 2:50 PM RONALD WYATT, M.D., PRESENTING AUTHOR GREGORY MALETIS, M.D. ANDREW AVINS, M.D., M.P.H. Introduction: Previous studies on the efficacy of preoperative antibiotics in preventing infections in patients undergoing knee arthroscopy (KA) have been either poorly designed or underpowered. The purpose of this study was to determine the association between the use of preoperative antibiotics and the risk of postoperative infection following simple KA. Methods: A health care organization’s electronic medical records were used to identify patients who underwent simple KA between 2007 and 2012. Patient demographics, potential infection risk factors, and prophylactic antibiotic administration data were extracted. Simple KA included
e9
debridement, synovectomy, meniscectomy, meniscus repair, and lateral release. Complex knee arthroscopy and arthroscopy for knee sepsis were excluded. Deep infection was defined as a positive synovial fluid culture or gross pus in the knee. Superficial infection was defined as clinical signs of infection localized to the portal sites treated with an antibiotic. Results: Of 44,112 simple knee arthroscopies, 35,518 (80.5%) received preoperative antibiotics and 8604 (19.5%) did not. The two treatment groups were similar with respect to patient demographics and infection risk factors. There were 30 deep infections in the antibiotic group (0.084%) and 11 in the non-antibiotic group (0.13%). There was no significant association between administering preoperative antibiotics and the risk of a deep infection (Risk Ratio (RR) ¼ 0.66, 95% Confidence Interval (CI): 0.33 to 1.32, p¼0.24). There were 156 superficial infections in the antibiotic group (0.44%) and 31 in the non-antibiotic group (0.36%); this difference was also not statistically significant (RR ¼ 1.30, 95% CI: 0.88 to 1.93, p¼0.23). Conclusion: In our large sample, there was no statistically significant association between preoperative antibiotic use and either deep or superficial infection. Any effect of preoperative antibiotic use is likely to be very small and must be balanced against the potential negative consequences, such as allergic reactions, clostridia difficile colitis, development of resistant organisms, and cost. Medial Quadriceps Tendon-Femoral Ligament (MQTFL) Reconstruction for Patellofemoral Instability SS-23 Thursday, April 23 at 2:55 PM BENJAMIN BARDEN, M.D., PRESENTING AUTHOR NICK REED, M.D. CORY EDGAR, M.D. JOHN FULKERSON, M.D. Introduction: The primary goal of this study was to provide minimum 2 year follow up patient-centered outcomes and the incidence of recurrent instability at an average of 36 months after MQTFL reconstruction. Methods: We identified all of our skeletally mature patients who underwent MQTFL reconstruction before March 2013 for recurrent lateral patellar dislocation refractory to non-operative treatment modalities. The MQTFL was reconstructed utilizing our previously published surgical technique (ArthroscopyTechniques.com) with anatomic bony graft fixation on the femur and softtissue fixation at the distal medial quadriceps tendon insertion. A retrospective chart review was conducted followed by patient examination when possible and a standardized patient questionnaire administered to all patients, focusing on the 2 year minimum follow-up cohort incidence of recurrent instability, patient satisfaction, and activity level. Results: Forty-six (46) knees in 45 patients, average age 19.5 years, underwent outpatient MQTFL reconstruction by the senior author. Twenty-nine (29) knees in 28