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Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine whether the bathing of an anterior cruciate ligament (ACL) autograft in vancomycin reduces the rate of infection following an ACL reconstruction.

Methods

Retrospective analysis of all ACL reconstructions over an 8-year period in two University Hospitals. In the initial 4-year period, all patients were operated on under classical antibiotic intravenous prophylaxis (group 1). Over the last 4-year period, this prophylaxis was supplemented with presoaking of the autograft (group 2). Presoaking was performed with sterile gauze previously saturated with a vancomycin solution (5 mg/ml).

Results

There were 810 and 734 patients in group 1 and 2, respectively. Fifteen cases of knee joint infections were identified in the series (0.97 %). All of these infections occurred in group 1, representing a rate of infection of 1.85 % in comparison with 0 % in group 2 (p < 0.001).

Conclusions

Autograft presoaking with vancomycin in combination with classical intravenous antibiotic prophylaxis reduced the rate of knee joint infection following an ACLR in comparison with antibiotic prophylaxis alone. This technique could be of relevance in daily clinical practice to prevent infection after ACLR.

Level of evidence

Case control study, retrospective comparative study, Level III.

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References

  1. Abdel-Aziz A, Radwan YA, Rizk A (2013) Multiple arthroscopic debridement and graft retention in septic knee arthritis after ACL reconstruction: a prospective case-control study. Int Orthop 38(1):73–82

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45(7):596–606

    Article  PubMed  Google Scholar 

  3. Armstrong RW, Bolding F, Joseph R (1992) Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 8(2):213–223

    Article  CAS  PubMed  Google Scholar 

  4. Barker JU, Drakos MC, Maak TG, Warren RF, Williams RJ 3rd, Allen AA (2009) Effect of graft selection on the incidence of postoperative infection in anterior cruciate ligament reconstruction. Am J Sports Med 38(2):281–286

    Article  PubMed  Google Scholar 

  5. Bostrom, Windhamre H, Mikkelsen C, Forssblad M, Willberg L (2014) Postoperative septic arthritis after anterior cruciate ligament reconstruction: does it affect the outcome? A retrospective controlled study. Arthroscopy. doi:10.1016/j.arthro.2014.03.019

  6. Cadet ER, Makhni EC, Mehran N, Schulz BM (2013) Management of septic arthritis following anterior cruciate ligament reconstruction: a review of current practices and recommendations. J Am Acad Orthop Surg 21(11):647–656

    Article  PubMed  Google Scholar 

  7. Edin ML, Miclau T, Lester GE, Lindsey RW, Dahners LE (1996) Effect of cefazolin and vancomycin on osteoblasts in vitro. Clin Orthop Relat Res 333:245–251

    Article  PubMed  Google Scholar 

  8. Gelber PE, Reina F, Torres R, Monllau JC (2010) Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique: a cadaveric study. Am J Sports Med 38(9):1877–1884

    Article  PubMed  Google Scholar 

  9. Gelber PE, Reina F, Torres R, Monllau JC (2010) Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique: a cadaveric study. Am J Sports Med 38(9):1877–1884

    Article  PubMed  Google Scholar 

  10. Grayson JE, Grant GD, Dukie S, Vertullo CJ (2011) The in vitro elution characteristics of vancomycin from tendons. Clin Orthop Relat Res 469(10):2948–2952

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hanssen AD (2005) Local antibiotic delivery vehicles in the treatment of musculoskeletal infection. Clin Orthop Relat Res 437:91–96

    Article  PubMed  Google Scholar 

  12. Judd D, Bottoni C, Kim D, Burke M, Hooker S (2006) Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 22(4):375–384

    Article  PubMed  Google Scholar 

  13. Kim YM, Joo YB (2012) Clinical presentation of staphylococcus epidermidis septic arthritis following anterior cruciate ligament reconstruction. Knee Surg Relat Res 24(1):46–51

    Article  PubMed  PubMed Central  Google Scholar 

  14. Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17(2):117–124

    Article  PubMed  Google Scholar 

  15. Maletis GB, Inacio MC, Reynolds S, Desmond JL, Maletis MM, Funahashi TT (2013) Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 41(8):1780–1785

    Article  PubMed  Google Scholar 

  16. Mouzopoulos G, Fotopoulos VC, Tzurbakis M (2009) Septic knee arthritis following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 17(9):1033–1042

    Article  PubMed  Google Scholar 

  17. Plante MJ, Li X, Scully G, Brown MA, Busconi BD, DeAngelis NA (2013) Evaluation of sterilization methods following contamination of hamstring autograft during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21(3):696–701

    Article  PubMed  Google Scholar 

  18. Portillo ME, Corvec S, Borens O, Trampuz A (2013) Propionibacterium acnes: an underestimated pathogen in implant-associated infections. Biomed Res Int 2013:804391

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schollin-Borg M, Michaelsson K, Rahme H (2003) Presentation, outcome, and cause of septic arthritis after anterior cruciate ligament reconstruction: a case control study. Arthroscopy 19(9):941–947

    Article  PubMed  Google Scholar 

  20. Sonnery-Cottet B, Archbold P, Zayni R, Bortolletto J, Thaunat M, Prost T, Padua VB, Chambat P (2011) Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes. Am J Sports Med 39(11):2371–2376

    Article  PubMed  Google Scholar 

  21. Sonnery-Cottet B, Thaunat M, Archbold P, Issartel B, Cadet ER (2014) Management of septic arthritis following anterior cruciate ligament reconstruction: a review of current practices and recommendations. J Am Acad Orthop Surg 22(5):271–273

    Article  PubMed  Google Scholar 

  22. Tanner J, Norrie P, Melen K (2011) Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev 9(11):CD004122

    Google Scholar 

  23. Torres-Claramunt R, Pelfort X, Erquicia J, Gil-Gonzalez S, Gelber PE, Puig L, Monllau JC (2012) Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc 21(12):2844–2849

    Article  PubMed  Google Scholar 

  24. Trampuz A, Zimmerli W (2006) Antimicrobial agents in orthopaedic surgery: prophylaxis and treatment. Drugs 66(8):1089–1105

    Article  CAS  PubMed  Google Scholar 

  25. Vertullo CJ, Quick M, Jones A, Grayson JE (2013) A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy 28(3):337–342

    Article  Google Scholar 

  26. Wang C, Lee YH, Siebold R (2014) Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22(9):2136–2144

    Article  PubMed  Google Scholar 

  27. Wasko MK, Borens O (2013) Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia: midterm results in 10 cases. Injury 44(8):1057–1060

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Mr. Eric L. Goode for his help with the English correction. We are also grateful to Prof Andrej Trampuz for his suggestions in the microbiological and infectious diseases field.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Consorci Parc de Salut Mar, Universitat Autònoma de Barcelona, Passeig Marítim, 25, Barcelona, Spain

    Daniel Pérez-Prieto, Raúl Torres-Claramunt, Xavier Pelfort & Joan Carles Monllau

  2. ICATME - Hospital Universitari Quirón-Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain

    Pablo E. Gelber, Xavier Pelfort & Joan Carles Monllau

  3. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Pablo E. Gelber

  4. Mohamed Dossary Hospital, Al Khobar, Saudi Arabia

    Tamer M. A. Shehata

Authors
  1. Daniel Pérez-Prieto
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  2. Raúl Torres-Claramunt
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  3. Pablo E. Gelber
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  4. Tamer M. A. Shehata
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  5. Xavier Pelfort
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  6. Joan Carles Monllau
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Correspondence to Daniel Pérez-Prieto.

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Pérez-Prieto, D., Torres-Claramunt, R., Gelber, P.E. et al. Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24, 2724–2728 (2016). https://doi.org/10.1007/s00167-014-3438-y

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  • DOI: https://doi.org/10.1007/s00167-014-3438-y

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