Presence of bacteria in failed anterior cruciate ligament reconstructions.

Hiller, N Luisa; Chauhan, Aakash; Palmer, Michael; Jain, Sameer; Sotereanos, Nicholas G; Altman, Gregory T; Nistico, Laura; Kreft, Rachael; Post, J Christopher; Demeo, Patrick J

BACKGROUND 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? METHODS We 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. RESULTS Bacteria 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. CONCLUSIONS 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.