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Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To survey members of The ACL study group to determine the current practice patterns surrounding the technique of pre-soaking ACL grafts in vancomycin.

Methods

A web-based questionnaire was distributed to members of the ACL Study Group. Questions included the use of vancomycin solution for graft soaking during ACL reconstruction, their protocol for soaking the graft, vancomycin concentration utilized, graft choices, and concerns with the technique.

Results

Sixty-six (57%) ACL surgeons completed the survey. Approximately one-third (37.9%) of respondents currently pre-soak their ACL grafts in vancomycin prior to implantation, with 60% of these surgeons being from Europe. Seventy-six percent have adopted this practice within the past 5 years. The majority of surgeons wrap the graft in a vancomycin-soaked gauze prior to implantation (56%), soak for a variable amount of time before implantation (56%), use a concentration of 5 mg/mL (68%), and soak hamstring grafts (92%). Concerns included the mechanical properties of the graft (35%), cost of vancomycin (23%), availability (12%), and antibiotic resistance (9%).

Conclusion

This survey demonstrates that 37.9% of ACL study group members currently utilize vancomycin to pre-soak ACL tendon grafts as a means to decrease post-operative infection risk, with the majority of surgeons having implemented this practice within the past 5 years. The biggest concern towards using vancomycin was the mechanical properties of the graft after soaking.

Level of evidence

IV.

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References

  1. Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8:213–223

    Article  CAS  Google Scholar 

  2. Banios K, Komnos GA, Raoulis V, Bareka M, Chalatsis G, Hantes ME (2020) Soaking of autografts with vancomycin is highly effective on preventing postoperative septic arthritis in patients undergoing ACL reconstruction with hamstrings autografts. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06040-2

    Article  PubMed  Google Scholar 

  3. Bansal A, Lamplot JD, Vandenberg J, Brophy RH (2018) Meta-analysis of the risk of infections after anterior cruciate ligament reconstruction by graft type. Am J Sports Med 46:1500–1508

    Article  Google Scholar 

  4. Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ, Allen AA (2010) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38:281–286

    Article  Google Scholar 

  5. Baron JE, Shamrock AG, Cates WT, Cates RA, An Q, Wolf BR et al (2019) Graft preparation with intraoperative vancomycin decreases infection after ACL reconstruction: a review of 1640 cases. J Bone Jt Surg Am 101:2187–2193

    Article  CAS  Google Scholar 

  6. Bohu Y, Klouche S, Sezer HB, Herman S, Grimaud O, Gerometta A et al (2020) Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05879-9

    Article  PubMed  PubMed Central  Google Scholar 

  7. Brophy RH, Wright RW, Huston LJ, Nwosu SK, Group MK, Spindler KP (2015) Factors associated with infection following anterior cruciate ligament reconstruction. J Bone Jt Surg Am 97:450–454

    Article  Google Scholar 

  8. Burks RT, Friederichs MG, Fink B, Luker MG, West HS, Greis PE (2003) Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med 31:414–418

    Article  Google Scholar 

  9. Ekdahl V, Stalman A, Forssblad M, Samuelsson K, Edman G, Kraus Schmitz J (2020) There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction: a nation-wide survey of ACL surgeons in Sweden. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05851-7

    Article  PubMed  PubMed Central  Google Scholar 

  10. Figueroa D, Figueroa F, Calvo R, Lopez M, Goñi I (2019) Presoaking of hamstring autografts in vancomycin decreases the occurrence of infection following primary anterior cruciate ligament reconstruction. Orthop J Sports Med 7(9):2325967119871038

    Article  Google Scholar 

  11. Greenberg DD, Robertson M, Vallurupalli S, White RA, Allen WC (2010) Allograft compared with autograft infection rates in primary anterior cruciate ligament reconstruction. J Bone Jt Surg Am 92:2402–2408

    Article  Google Scholar 

  12. Heckmann ND, Mayfield CK, Culvern CN, Oakes DA, Lieberman JR, Della Valle CJ (2019) Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. J Arthroplasty 34:1815–1822

    Article  Google Scholar 

  13. Indelli PF, Dillingham M, Fanton G, Schurman DJ (2002) Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 398:182–188

    Article  Google Scholar 

  14. Jacquet C, Jaubert M, Pioger C, Sbihi A, Pithioux M, Le Baron M et al (2020) Presoaking of semitendinosus graft with vancomycin does not alter its biomechanical properties: a biomechanical in vitro-controlled study using graft from living donors. Arthroscopy. https://doi.org/10.1016/j.arthro.2020.03.037

    Article  PubMed  Google Scholar 

  15. Judd MAJD, Bottoni LTCC, Kim D, Burke CPTM, Hooker MAJS (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22:375–384

    Article  Google Scholar 

  16. Lee YP, Farhan SD, Pendi A, Cunningham TJ, Kiester PD, Hahn P et al (2018) Does addition of tobramycin powder reduce infection rates after spine surgery? Glob Spine J 8:816–820

    Article  Google Scholar 

  17. Maletis GB, Inacio MCS, Reynolds S, Desmond JL, Maletis MM, Funahashi TT (2013) Incidence of postoperative anterior cruciate ligament reconstruction infections. Am J Sports Med 41:1780–1785

    Article  Google Scholar 

  18. Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr et al (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42:2363–2370

    Article  Google Scholar 

  19. Mariscalco MW, Magnussen RA, Mehta D, Hewett TE, Flanigan DC, Kaeding CC (2014) Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction. Am J Sports Med 42:492–499

    Article  Google Scholar 

  20. McAllister DR, Parker RD, Cooper AE, Recht MP, Abate J (1999) Outcomes of postoperative septic arthritis after anterior cruciate ligament reconstruction. Am J Sports Med 27:562–570

    Article  CAS  Google Scholar 

  21. Nwachukwu BU, Chang B, Voleti PB, Berkanish P, Cohn MR, Altchek DW et al (2017) Preoperative short form health survey score is predictive of return to play and minimal clinically important difference at a minimum 2-year follow-up after anterior cruciate ligament reconstruction. Am J Sports Med 45:2784–2790

    Article  Google Scholar 

  22. Offerhaus C, Balke M, Hente J, Gehling M, Blendl S, Höher J (2019) 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

    Article  Google Scholar 

  23. Patel NN, Guild GN, Kumar AR (2018) Intrawound vancomycin in primary hip and knee arthroplasty: a safe and cost-effective means to decrease early periprosthetic joint infection. Arthroplasty Today 4:479–483

    Article  Google Scholar 

  24. Pérez-Prieto D, Torres-Claramunt R, Gelber PE, Shehata TMA, Pelfort X, Monllau JC (2016) Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24:2724–2728

    Article  Google Scholar 

  25. Phegan M, Grayson JE, Vertullo CJ (2016) No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc 24:2729–2735

    Article  Google Scholar 

  26. Schuster P, Schlumberger M, Mayer P, Eichinger M, Geßlein M, Reddemann F et al (2020) Soaking of the graft in vancomycin dramatically reduces the incidence of postoperative septic arthritis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05882-0

    Article  PubMed  Google Scholar 

  27. Takahashi H, Iida Y, Yokoyama Y, Hasegawa K, Tsuge S, Fukutake K et al (2018) Use of intrawound vancomycin powder against postoperative infection after spine surgery. Spine Surg Relat Res 2:18–22

    Article  Google Scholar 

  28. Thompson GH, Poe-Kochert C, Hardesty CK, Son-Hing J, Mistovich RJ (2018) Does vancomycin powder decrease surgical site infections in growing spine surgery? A preliminary study. J Bone Jt Surg Am 100:466–471

    Article  Google Scholar 

  29. Vertullo CJ, Quick M, Jones A, Grayson JE (2012) A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy 28:337–342

    Article  Google Scholar 

  30. Wang C, Ao Y, Wang J, Hu Y, Cui G, Yu J (2009) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, presentation, treatment, and cause. Arthroscopy 25:243–249

    Article  Google Scholar 

  31. Wang C, Lee YH, Siebold R (2014) Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2136–2144

    Article  Google Scholar 

  32. Watanakunakorn C (1984) Mode of action and in-vitro activity of vancomycin. J Antimicrob Chemother 14(Suppl D):7–18

    Article  CAS  Google Scholar 

  33. Waterman BR, Arroyo W, Cotter EJ, Zacchilli MA, Garcia EJ, Owens BD (2018) Septic arthritis after anterior cruciate ligament reconstruction: clinical and functional outcomes based on graft retention or removal. Orthop J Sports Med 6:2325967118758626

    Article  Google Scholar 

  34. Xiao M, Leonardi EA, Sharpe O, Sherman SL, Safran MR, Robinson WH et al (2020) Soaking of autologous tendon grafts in vancomycin prior to implantation does not lead to tenocyte toxicity. Am J Sports Med (In Press)

  35. Yavuz IA, Oken OF, Yildirim AO, Inci F, Ceyhan E, Gurhan U (2020) No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases. Knee Surg Sports Traumatol Arthrosc 28(9):3055–3060

    Article  Google Scholar 

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Acknowledgements

We would like to thank the members of the ACL study group who participated in our survey.

Funding

None.

Author information

Authors and Affiliations

Authors

Contributions

Study conception and design: MX, SLS, MRS, and GDA. Acquisition of data: MX, SLS, MRS, GDA. Analysis and interpretation of data: MX, GDA. Drafting of manuscript: MX, SLS, MRS, GDA. Critical revision: MX, SLS, MRS, GDA.

Corresponding author

Correspondence to Geoffrey D. Abrams.

Ethics declarations

Conflict of interest

Michelle Xiao declares no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Seth L. Sherman has the following disclosures: ACL Study Group: Board or committee member; American Journal of Orthopedics: Editorial or governing board; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthrex, Inc: Paid consultant; Research support; Arthroscopy: Editorial or governing board; Arthroscopy Association of North America: Board or committee member; Ceterix Orthopaedics: Paid consultant; CONMED Linvatec: Paid consultant; Flexion Therapeutics: Paid consultant; GLG Consulting: Paid consultant; International Cartilage Regeneration & Joint Preservation Society: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; JRF Ortho: Paid consultant; Moximed: Paid consultant; Olympus: Paid consultant; Vericel: Paid consultant. Marc R Safran has the following disclosures: American Journal of Sports Medicine: Editorial or governing board; Biomimedica: Stock or stock Options; Unpaid consultant; DJ Orthopaedics: IP royalties; International Society for Hip Arthroscopy: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; JISAKOS: Editorial or governing board; Journal of Hip Preservation Surgery: Editorial or governing board; Medacta: Paid consultant; Paid presenter or speaker; Saunders/Mosby-Elsevier: Publishing royalties, financial or material support; Smith & Nephew: IP royalties; Paid presenter or speaker; Research support; Stryker: IP royalties; Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Geoffrey D Abrams has the following disclosures: AAOS: Board or committee member; American Orthopaedic Society for Sports Medicine: Board or committee member; Arthrex, Inc: Other financial or material support; Cytonics Inc.: Paid consultant; Stock or stock Options; Fidia Pharma: Paid consultant; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; RubiconMD: Paid consultant; Sideline Sports Doc: Paid consultant; Stryker: Other financial or material support; TeachAIDS: Unpaid consultant.

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Xiao, M., Sherman, S.L., Safran, M.R. et al. Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group. Knee Surg Sports Traumatol Arthrosc 29, 1920–1926 (2021). https://doi.org/10.1007/s00167-020-06265-1

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