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No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts

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

Abstract

Purpose

To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction.

Methods

This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL.

Results

In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher’s exact test (P = 0.0011) and Chi-square test with Yates’ correction (P = 0.0003).

Conclusions

Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedics, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast, QLD, 4215, Australia

    Michael Phegan

  2. Department of Kinesiology and Health Sciences, Stephen F. Austin State University, Nacogdoches, TX, USA

    Jane E. Grayson

  3. Knee Research Australia, Centre for Musculoskeletal Research, Griffith University, Gold Coast, QLD, Australia

    Christopher J. Vertullo

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  1. Michael Phegan
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  2. Jane E. Grayson
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  3. Christopher J. Vertullo
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Correspondence to Michael Phegan.

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Phegan, M., Grayson, J.E. & Vertullo, C.J. No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc 24, 2729–2735 (2016). https://doi.org/10.1007/s00167-015-3558-z

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