Summary

ACL graft rinsing with running saline solution before graft implantation appears promising and might be an alternative method to prevent septic arthritis caused by graft contamination

Abstract

Infection after arthroscopic ACL reconstruction is a rare but serious complication ranging in incidence from 0.14 to 1.7%. One of the reasons for postoperative septic arthritis is graft contamination from the skin or instruments during graft preparation and manipulation outside the body.
Previous studies have reported that pre-soaking the ACL graft with vancomycin reduces postoperative septic arthritis to 0%.
However, in some countries it is not possible to use vancomycin for pre-soaking the ACL graft during surgery because of legal regulations.
The aim of the study was to investigate if rinsing of the ACL graft with saline after preparation and manipulation outside the body can prevent postoperative septic arthritis.

Material And Methods

From September 2013 to August 2020, 588 ACL reconstruction were performed by two surgeons at the same institution using hamstring tendon autograft in 445 patients, BTB autograft in 130, QT autograft in 10 and Achilles tendon allograft in 3 patients. The mean age of the patients was 29 (14 – 60) years.
In 587/588 cases a single prophylactic dose of 1 gram of cephazolin was given preoperatively. The mean time the graft was outside of body was 16 (2 – 38) minutes.
In 288/588 patients running saline rinsing was performed for one minute before implantation in the joint, in 300/588 patients no rinsing was performed.

Results

In patients who underwent saline rinsing of the graft no postoperative septic knees were found, while 5/300 (1.7%) patients who did not undergo rinsing suffered a septic knee (p=0.062).

Conclusion

ACL graft rinsing with running saline solution before graft implantation appears promising and might be an alternative method to prevent septic arthritis caused by graft contamination.A larger study is needed before definitive recommendations can be given.