{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:01:39Z","timestamp":1791435699001,"version":"4.3.3"},"reference-count":30,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:00:00Z","timestamp":1551225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T00:00:00Z","timestamp":1551225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine if tunnel widening, defined as change in maximal tunnel diameter from the time of initial bone tunnel drilling to revision surgery is associated with bacterial deoxyribonucleic acid (DNA) presence and concentration in torn graft tissue from failed anterior cruciate ligament reconstructions (ACLRs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010four consecutive revision ACLRs were included (mean age 27.3 years SD 10.9; median time to failure 4.9 years range 105\u00a0days\u201320 years). Graft selection of the failed reconstruction was 68% autograft, 26% allograft, and 6% autograft\/allograft hybrid with a mean drilled tunnel diameter of 8.4\u00a0mm SD 0.8. Maximal tunnel diameters prior to revision were measured on pre\u2010operative three\u2010dimensional imaging and compared to drilled tunnel diameters at the time of the previous reconstruction. Tissue biopsies of the failed graft were obtained from tibial, femoral, and intraarticular segments. Sterile water left open to air during revision ACLRs and tissue from primary ACLRs were used as negative controls. Clinical cultures were obtained on all revision ACLRs and PCR with universal bacterial primer on all cases and negative controls. Fluorescence microscopy was used to confirm the presence and location of biofilms in two patients with retrieved torn graft tissue and fixation material. Amount of tunnel widening was compared to bacterial DNA presence as well as bacterial DNA concentration via Welch ANOVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bacterial DNA was present in 29\/34 (85%) revision ACLRs, 1\/5 (20%) of primary ACLR controls and 0\/3 (0%) sterile water controls. Cultures were positive (coagulase negative <jats:italic>Staphylococcus<\/jats:italic> sp.) in one case, which also had the greatest degree of tunnel widening. Femoral widening was greater in cases with detectable bacterial DNA (mean widening 2.6\u00a0mm SD 3.0) versus without (mean 0.3\u00a0mm SD 0.6) (<jats:italic>p<\/jats:italic>\u2009=\u20090.003) but was unaffected by bacterial DNA concentration (<jats:italic>p<\/jats:italic>\u2009=\u20090.44). Tibial widening was not associated with the presence of bacterial DNA (n.s.); however, higher bacterial DNA concentrations were observed in cases with tibial widening \u2265\u20093.0\u00a0mm (median 2.47\u00a0ng bacterial DNA\/\u00b5g total DNA) versus widening &lt;\u20093.0\u00a0mm (median 0.97\u00a0ng bacterial DNA\/\u00b5g total DNA) (<jats:italic>p<\/jats:italic>\u2009=\u20090.046). Tunnel widening was not associated with time to failure, graft selection, or number of prior surgeries (n.s., all comparisons). Fluorescence microscopy confirmed the presence of biofilms on ruptured tendon graft as well as fixation material in 2\/2 cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Bacterial DNA is commonly encountered on failed ACLR grafts and can form biofilms. Bacterial DNA does not cause clinically apparent infection symptoms but is associated with tunnel widening. Further research is needed to determine whether graft decontamination protocols can reduce graft bacterial colonization rates, ACLR tunnel widening or ACLR failure risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Therapeutic III.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-019-05405-6","type":"journal-article","created":{"date-parts":[[2019,2,27]],"date-time":"2019-02-27T19:57:49Z","timestamp":1551297469000},"page":"3490-3497","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Bacterial DNA is associated with tunnel widening in failed ACL reconstructions"],"prefix":"10.1002","volume":"27","author":[{"given":"David C.","family":"Flanigan","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"},{"name":"<!--<label>2<\/label>--> Sports Medicine Research Institute The Ohio State University Wexner Medical Center 2835 Fred Taylor Dr 43202 Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua S.","family":"Everhart","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex C.","family":"DiBartola","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devendra H.","family":"Dusane","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Department of Microbial Infection and Immunity The Ohio State University Columbus USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moneer M.","family":"Abouljoud","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"},{"name":"<!--<label>2<\/label>--> Sports Medicine Research Institute The Ohio State University Wexner Medical Center 2835 Fred Taylor Dr 43202 Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Magnussen","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"},{"name":"<!--<label>2<\/label>--> Sports Medicine Research Institute The Ohio State University Wexner Medical Center 2835 Fred Taylor Dr 43202 Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C.","family":"Kaeding","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"},{"name":"<!--<label>2<\/label>--> Sports Medicine Research Institute The Ohio State University Wexner Medical Center 2835 Fred Taylor Dr 43202 Columbus OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Stoodley","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedics The Ohio State University Wexner Medical Center Columbus USA"},{"name":"<!--<label>3<\/label>--> Department of Microbial Infection and Immunity The Ohio State University Columbus USA"},{"name":"<!--<label>4<\/label>--> National Centre for Advanced Tribology, Department of Mechanical Engineering Southampton University Southampton 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August 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Paul Stoodley receives funding from Biocomposites Ltd., 3M Orthopaedics, Smith & Nephew, and Zimmer Biomet. David C. Flanigan receives funding from Depuy Mitek Inc., Smith & Nephew, Vericel, Ceterix Orthopaedics, Conmed, Histogenics Corporation, Moximed, and Zimmer Biomet.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}