Targeted intervention of acute postoperative infection after rotator cuff repair results in good functional outcomes
Bibliographic record
Abstract
PURPOSE: The primary goal of this retrospective review of a prospective database was to document the functional results after acute postoperative deep infection following rotator cuff repair in a single orthopaedic unit over a period of 5 years. Secondary goals were to document the effect of infection on healing of the cuff repair and to describe its incidence, diagnostic challenges, pathogens and management. METHODS: Patients undergoing arthroscopic rotator cuff repair were prospectively registered from 2010 to 2014. Eleven out of 1072 repairs developed an acute postoperative infection. The patients were examined with an MRI scan, Constant-Murley (CM) score and the Western Ontario Rotator Cuff Index (WORC) at final follow-up (median of 22 months). RESULTS: All 11 patients who developed acute postoperative deep infections were males. Median age was 56 years (range 41-68). All patients underwent arthroscopic debridement and biopsies were collected at a median of 26 days (range 14-50) after primary surgery. In ten patients, Propionibacterium acnes was cultured, six of these patients also had positive cultures for coagulase-negative staphylococci. In the remaining patient, only coagulase-negative staphylococcus was cultured. Five patients were treated with one arthroscopic debridement, five had two arthroscopic debridements and one required arthroscopic debridement four times before the infection was eradicated. Two patients had their implants removed due to loosening of the suture anchors. All patients were treated with parenteral antibiotics for 1-4 weeks, followed by oral treatment for 1-5 weeks. At median 22 months (range 11-28) follow-up the median CM score was 84 and median WORC index was 81%. Ten patients had a postoperative MRI scan after a median of 23 months (range 3-49), with eight presenting a healed cuff repair. CONCLUSION: The findings of this study support the rapid, targeted intervention of acute postoperative infection after RC repair with immediate arthroscopic debridement, irrigation and biopsies for bacteriological diagnostics followed by parenteral antibiotics. Furthermore, repeated arthroscopic debridement and irrigation are recommended if signs of infection persist. Removal of the implant is rarely needed. Despite the postoperative acute infection, these patients presented good functional results at final follow-up. LEVEL OF EVIDENCE: Level III.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".