Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction

Abstract

Purpose

To investigate whether pre-soaking the graft in vancomycin during anterior cruciate ligament reconstruction (ACLR) reduces the postoperative infection rate and if this technique is associated with an increased rate of complications, including graft failure or arthrofibrosis.

Methods

A retrospective review of a prospective database was performed in 1779 patients who underwent ACLR over a period of 5 years, analysing the rate of postoperative deep knee infection. Group 1 and 2 both received perioperative IV antibiotics, while only group 2 underwent ACLR with grafts pre-soaked in a 5 mg/ml vancomycin solution. To analyse possible side effects associated with vancomycin use, 500 patients out of the overall study population (100 patients per year) were randomly selected and retrospectively interviewed for further postoperative complications including graft failure and arthrofibrosis as well as subjective evaluation of their knee by completing the IKDC form with a minimum mean follow-up of 37 months.

Results

In group 1, 22 out of 926 (2%) patients suffered a postoperative deep knee infection. In contrast, there were no postoperative infections in the second group of 853 patients (0%). 16 of 22 infections (73%) were caused by coagulase-negative Staphylococcus. Statistical analysis revealed a significantly reduced postoperative infection rate when bathing the autograft in vancomycin (p < 0.01). Analysis of the random sample revealed a significant decrease of graft failure with 8 reruptures in 257 patients (3%) in the vancomycin group compared to 16 cases of graft failure in 167 patients (10%) in the control group (p < 0.05). No differences were found in the rate of postoperative arthrofibrosis, Tegner or subjective outcome scores.

Conclusion

Prophylactic vancomycin pre-soaking of autografts during ACLR appears to be a viable, cost-effective and safe option to reduce the rate of deep infection compared to systemic antibiotics alone.

Level of evidence

III.

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Abbreviations

ACLR:

Anterior cruciate ligament reconstruction

CNS:

Coagulase-negative Staphylococcus

MIC:

Minimum inhibitory concentration

ST:

Semitendinosus

HS:

Hamstrings

PT:

Bone–patellatendon–bone

QT:

Quadriceps tendon

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Acknowledgements

The authors gratefully acknowledge Nate Breznau and Ajay C. Kanakamedala for language editing.

Funding

The authors did not receive any funding for the study.

Author information

Affiliations

Authors

Contributions

JH performed the surgeries on all patients. MB and CO were assisting in surgeries and examining the patients and evaluating them clinically during follow-up. JH, MB, and CO developed the study design. JuHe, MG and SB did the patient interviews and helped analysing and interpreting literature and data. CO and JuHe performed the literature review and wrote the manuscript. CO did the statistical analysis. JH and MB were proof reading the manuscript and revising it critically. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Jürgen Höher.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

Institutional ethics committee approval was obtained prior to the start of this study (University Witten/Herdecke; ID: 1792015).

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Offerhaus, C., Balke, M., Hente, J. et al. Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 3014–3021 (2019). https://doi.org/10.1007/s00167-018-5323-6

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Keywords

  • Anterior cruciate ligament
  • Antibiotic prophylaxis
  • Vancomycin
  • Knee infection
  • Graft failure
  • Arthrofibrosis