Summary

We propose soaking the graft in vancomycin in order to prevent the patients from septic arthritis after ACL reconstruction

Abstract

Purpose

Septic arthritis after ACL reconstruction is a devastating complication. In recent years graft soaking with Vancomycin has been proposed as a solution to eliminate this complication. The purpose of the present study is to access how the vancomycin solution protects the Hamstrings autograft during harvesting and preparation.

Material And Methods

The study material consisted of 40 patients operated on for ACL reconstruction with a Hamstring tendons autograft. In 20 patients the graft was soaked in vancomycin (Group A) while in 20 (Group B) the graft was not soaked in vancomycin. We used strict criteria for this study; all patients were operated from the same surgeon, with the same technique, the same way of tendon harvesting and preparation. Only patient with isolated ACL reconstruction were included in this study. In all the patients we calculated the time of graft harvesting, and the total time of surgery. In all patients we used the same antibiotic for infection prevention ( 1 dose prior and two doses after the operation). After fixation of the graft to the tibia with an interference screw and a staple, the rest of the tissue was send for culture. All the cultures were incubated in 37°C with 5% CO2 in agar plates for 5 days and inspected daily for microbial growth. Any bacterial growth and the number of colony forming were reported.

Results

There was no statistical difference in harvesting time and total operation time between the 2 groups. On the other hand 11 patients (60%) in group B were positive while no patient in Group A was positive. This difference was statistically significant (p<0.01). All cultures were positive for the same microorganism, coagulase-negative staphylococcus (CNS). Thus soaking the graft with vancomycin protects the infection during harvesting and preparation of the graft.

Conclusions

In this series Hamstring tendons autograft harvesting and preparation leads to bacterial contamination in 60% of the cases. On the other hand there is no contamination after soaking the graft with vancomycin. On the basis of this study we propose soaking the graft in vancomycin in order to prevent the patients from septic arthritis after ACL reconstruction.