Introduction

Postoperative infection following anterior cruciate ligament (ACL) reconstruction is a known complication associated with significant morbidity including reoperation and inferior long-term clinical outcomes. Intraoperative ACL graft preparation with vancomycin irrigant has been shown to significantly reduce the rate of infection in large cohort studies. However, the effect of vancomycin on patient reported outcomes and graft failure is currently poorly understood. The purpose of the current study was to evaluate 2-year patient reported outcomes (PROs) and graft failure stratified by intraoperative vancomycin use.

Methods

A retrospective review of prospectively collected data was performed on all primary ACL reconstructions performed between May 2012 and August 2018 at a single academic medical center. Patients completed RAND 36-item Short-Form (SF-36 Physical [PCS] and Mental [MCS] Component Summary scores), Knee Injury and Osteoarthritis Outcome Score (KOOS pain, activities of daily living [ADL], quality of life [QOL], function in sport and recreation [Sport/Rec], and other symptoms subscales), and Marx Activity Rating Scale (MARS) instruments preoperatively as well as 6 months and 2 years following ACL reconstruction. Information regarding additional knee injuries or surgeries was collected at time of final recorded follow-up. Revision ACL reconstructions and patients with incomplete PRO data or less than 2-year follow-up were excluded. Cases were stratified based on vancomycin use. Statistical analysis was performed utilizing Student’s t-test and chi square analyses as appropriate, with significance defined as p<0.05.

Results

In total, 408 primary ACL reconstructions (210 males; 51.5%) with a mean age of 25.1+10.3 years were included in the study. Intraoperative vancomycin was used in 283 cases (69.3%), while 125 ACL reconstructions (30.6%) were performed without the use of vancomycin. The vancomycin cohort exhibited no difference in SF-36, KOOS, and MARS scores preoperatively as well as at 6 months and 2 years following ACL reconstruction compared to patients who underwent ACL reconstruction without the use of vancomycin. Additionally, there was no difference observed in the rate of ACL graft failure between vancomycin (n=7; 2.5%) and non-vancomycin (n=4; 3.2%) treated grafts (p=0.676).

Conclusion

Intraoperative graft preparation with vancomycin irrigant has no effect on 2-year PROs and graft failure rates following primary ACL reconstruction.