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Author: search.filters.author.David FigueroaSubject: search.filters.subject.human

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    Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review
    (2021)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    Alex Vaisman
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    David Figueroa  
    ;
    João Espregueira-Mendes
    <jats:p> Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. </jats:p><jats:p> Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059 </jats:p>
      1Scopus© Citations 7
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    Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction
    (2020)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    David Figueroa
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Alex Vaisman
    ;
    João Espregueira-Mendes
    <jats:p> There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic. Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft. When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee. </jats:p><jats:p> Cite this article: EFORT Open Rev 2020;5:221-225. DOI: 10.1302/2058-5241.5.190049 </jats:p>
      2Scopus© Citations 10
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    Scopus© Citations 8  3
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    Assessment of Cell Viability of Fresh Osteochondral Allografts in N-Acetylcysteine-Enriched Medium
    (2020)
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Maximiliano Espinosa
    ;
    David Figueroa
    ;
    Luz María Pozo
    ;
    CONGET MOLINA, PAULETTE ANDREA  
    <jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this study was to evaluate the effect of N-acetylcysteine (NAC)-enriched storage medium on fresh osteochondral viability at 4°C. Our hypothesis was that the cell viability of chondrocytes obtained from human osteochondral tissue and stored at 4°C significantly improves in the presence of NAC. </jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p> Controlled laboratory study. For this study, 8 samples of femoral condyle osteochondral tissue were obtained from patients undergoing total knee replacement. The samples were stored at either 4°C in phosphate-buffered saline (PBS) or at 3 different concentrations of NAC (NAC 1, 2, and 5 mM). Cell viability was analyzed at time 0 and 4 weeks by flow cytometry. The results of cell viability (median) were analyzed statistically using analysis of variance and Tukey’s post hoc test. P values &lt;0.05 were considered statistically significant. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The viability at time 0 was 95.5% ± 3.7%. At 4 weeks, the cell viability was 56.8% ± 20.1% in the control group (PBS), 83.8% ± 11.9% in the group stored with NAC 1 mM, 73.4% ± 13.6% in the group stored with NAC 2 mM, and 66.4% ± 27.7% in the group stored with NAC 5 mM. A statistically significant difference from the baseline viability (time 0) was observed in the PBS control group ( P = 0.0018) but not in the other groups. A statistically significant difference was observed in the NAC 1 mM group compared with the PBS group ( P = 0.0255). </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> The use of NAC at 1 mM concentration improves cell viability after 4 weeks of storage in chondrocytes obtained from human osteochondral tissue. </jats:p></jats:sec>
      1  1Scopus© Citations 11
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    Scopus© Citations 7  1
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    Presoaking of Hamstring Autografts in Vancomycin Decreases the Occurrence of Infection Following Primary Anterior Cruciate Ligament Reconstruction
    (2019)
    David Figueroa
    ;
    Francisco Figueroa  
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Mario Lopez
    ;
    Ignacio Goñi
    <jats:sec><jats:title>Background:</jats:title><jats:p> Postoperative septic arthritis is an uncommon but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with vancomycin to decrease this risk. </jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p> To compare the rate of septic arthritis in primary hamstring autograft ACL reconstruction with and without vancomycin-presoaked grafts. </jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p> Cohort study; Level of evidence, 3. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Consecutive periods were studied, inclusive of April 2013 through October 2015 (pre-vancomycin protocol) and November 2015 through May 2018 (vancomycin protocol). A total of 490 patients were included in the study: 230 in the pre-vancomycin protocol and 260 in the vancomycin protocol. All patients who underwent a primary hamstring autograft ACL reconstruction by 2 senior surgeons during the periods studied were included. The final outcome studied was occurrence of highly probable postoperative septic arthritis in both groups. Diagnosis of probable septic arthritis was made by clinical diagnosis as well as cytological analysis of joint aspiration (cell count &gt;50,000/μL and &gt;90% neutrophils). Statistical analysis was performed with the Fisher exact test. Significance was set at P &lt; .05. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Four cases of probable postoperative septic arthritis were noted in the pre-vancomycin protocol (1.7%; 2 cases per surgeon), while no cases of septic arthritis were noted in the vancomycin protocol during the study period ( P &lt; .05). Diagnosis was made at a mean 21.7 days (range, 16-25 days). Staphylococcus epidermidis was isolated in 2 cases, and in the other 2 cases, no organism was isolated. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Presoaking of hamstring autografts in vancomycin for primary ACL reconstruction prevented the occurrence of postoperative septic arthritis during the study period as compared with no soaking of the grafts. </jats:p></jats:sec>
      13Scopus© Citations 31