Soaking of autografts in vancomycin is highly effective in preventing postoperative septic arthritis after revision anterior cruciate ligament reconstruction

  • Philipp SchusterEmail author
  • Michael Schlumberger
  • Philipp Mayer
  • Martin Eichinger
  • Markus Geßlein
  • Jörg Richter



To determine and compare the incidence of postoperative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre series.


A total of 2155 isolated R-ACLR with autologous tendons were performed from 2004 to 2019 and were reviewed with regard to the occurrence of postoperative septic arthritis. From February 2017 onwards, all grafts were wrapped in a vancomycin-soaked (5 mg/ml) gauze swab between harvest and implantation (517 patients, treatment group (2), prospectively followed). These were compared to 1638 patients before that date (control group (1), retrospectively evaluated). The technique of R-ACLR did not significantly change during the years of the study. Hamstring tendons were used in 1310 patients (60.8%) and quadriceps tendons with patellar bone block were used in 845 patients (39.2%), respectively, with no difference between the groups (n.s.). Routine follow-up examination was performed 6 weeks postoperatively (follow-up rate 96.5%), and patients with no treatment for septic arthritis until that time were classified as non-infected.


There were 14 cases of postoperative septic arthritis in group 1 (incidence 0.9%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p = 0.029).


Soaking of the graft in vancomycin solution prior to implantation dramatically reduces the incidence of postoperative septic arthritis in R-ACLR.

Level of evidence



Infection ACL Anterior cruciate ligament Septic arthritis Complication Prevention Antibiotics Vancomycin Local Revision Failure Arthroscopy 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.


The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

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. The study was approved by the competent Ethical committee.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Philipp Schuster
    • 1
    • 2
    Email author
  • Michael Schlumberger
    • 1
    • 3
  • Philipp Mayer
    • 1
  • Martin Eichinger
    • 1
    • 3
  • Markus Geßlein
    • 2
  • Jörg Richter
    • 1
  1. 1.Centre for Arthroscopy and Special Joint SurgeryOrthopedic Hospital MarkgroeningenMarkgroeningenGermany
  2. 2.Department of Orthopedics and TraumatologyParacelsus Medical Private University, Clinic NurembergNurembergGermany
  3. 3.Department of Trauma SurgeryMedical University InnsbruckInnsbruckAustria

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