Surgical Site Infection Following Extracapsular Cranial Cruciate Ligament Repair

Jonathan Miller, DVM, MS, DACVS (Small Animal), Oradell Animal Hospital, Paramus, New Jersey

Orthopedics

November/December 2021

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In the Literature

Cox T, Maddox TW, Pettitt R, Wustefeld-Janssens B, Innes J, Comerford E. Investigation of variables associated with surgical site infection following the management of canine cranial cruciate ligament rupture with a lateral fabellotibial suture. Vet Comp Orthop Traumatol. 2020;33(6):409-416.

FROM THE PAGE…

Surgical site infection (SSI) is an important cause of morbidity in dogs. Previous studies based on older guidelines from the Centers for Disease Control and Prevention have reported SSI rates of <5% for the lateral fabellar nylon suture technique, a procedure used for cranial cruciate ligament (CCL) repair.^1,2

This study examined SSI rates and contributing variables for lateral suture surgery of the stifle joint in dogs; 150 surgical procedures in 130 dogs were evaluated, and the SSI rate was found to be 17.3%. Of these, infected joints were found in 73.1% of dogs; 53% of affected dogs required implant removal. All infections were Staphylococcus spp, with only 10.5% of isolates being methicillin resistant. Although all dogs received perioperative β-lactam antibiotics, only 13.3% received a postoperative antibiotic course. Postoperative antibiotics have been associated with reduced SSI in some CCL studies.^3,4

Variables significantly associated with SSI included increased body weight and use of propofol instead of alfaxalone as an anesthetic induction agent. For each 2.2-lb (1-kg) increase in body weight, the SSI rate increased 4%. Use of propofol was associated with a 3.6-fold increase.

… TO YOUR PATIENTS

Key pearls to put into practice:

Heavier dogs have a higher risk for postoperative infection of the stifle joint after lateral fabellotibial nylon suture surgery for CCL rupture.

Dogs receiving alfaxalone as an anesthetic induction agent for lateral fabellotibial nylon suture repair may have lower risk for SSI than when propofol is used.

If SSI occurs after extracapsular suture repair for CCL rupture, the lateral suture may need to be removed in ≈50% of cases.

References

Casale SA, McCarthy RJ. Complications associated with lateral fabellotibial suture surgery for cranial cruciate ligament injury in dogs: 363 cases (1997-2005). J Am Vet Med Assoc. 2009;234(2):229-235.
Frey TN, Hoelzler MG, Scavelli TD, Fulcher RP, Bastian RP. Risk factors for surgical site infection-inflammation in dogs undergoing surgery for rupture of the cranial cruciate ligament: 902 cases (2005-2006). J Am Vet Med Assoc. 2010;236(1):88-94.
Pratesi A, Moores AP, Downes C, Grierson J, Maddox TW. Efficacy of postoperative antimicrobial use for clean orthopedic implant surgery in dogs: a prospective randomized study in 100 consecutive cases. Vet Surg. 2015;44(5):653-660.
Spencer DD, Daye RM. A prospective, randomized, double-blinded, placebo-controlled clinical study on postoperative antibiotherapy in 150 arthroscopy-assisted tibial plateau leveling osteotomies in dogs. Vet Surg. 2018;47(8):E79-E87.

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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