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Background: The use of the vancomycin wrap to pretreat the hamstring graft in anterior cruciate ligament reconstruction (ACLR) has grown in popularity since it was first described in 2012 and has significantly reduced rates of postoperative infection. However, it remains unknown if this antibiotic treatment affects the molecular composition of the graft. Purpose: To establish whether treatment with vancomycin at 5 mg/mL, the most commonly used concentration, alters the molecular function of the hamstring graft in ACLR. Study Design: Controlled laboratory study. Methods: Surplus hamstring tendon collected after routine ACLR surgery was used for in vitro cell culture and ex vivo tissue experiments. Vancomycin was used at 5 mg/mL in RPMI or saline diluent to treat cells and tendon tissue, respectively, with diluent control conditions. Cell viability at 30, 60, and 120 minutes was assessed via colorimetric viability assay. Tendon cells treated with control and experimental conditions for 1 hour was evaluated using semiquantitative reverse transcription analysis, immunohistochemistry staining, and protein quantitation via enzyme-linked immunosorbent assay for changes in apoptotic, matrix, and inflammatory gene and protein expression. Results: Vancomycin treatment at 5 mg/mL significantly reduced tenocyte viability in vitro after 60 minutes of treatment ( P < .05); however, this was not sustained at 120 minutes. Vancomycin-treated tendon tissue showed no significant increase in apoptotic gene expression, or apoptotic protein levels in tissue or supernatant, ex vivo. Vancomycin was associated with a reduction in inflammatory proteins from treated tendon supernatants (IL-6; P < .05). Conclusion: Vancomycin did not significantly alter the molecular structure of the hamstring graft. Reductions in matrix protein and inflammatory cytokine release point to a potential beneficial effect of vancomycin in generating a homeostatic environment. Clinical Relevance: Vancomycin ACL wrap does not alter the molecular structure of the ACL hamstring graft and may improve graft integrity.

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content. Tool apps are those used by patients to track symptoms, contained lupus action plan, appointment and medication reminders, and/or quizzes/gamification. App features included connection to external sites (social media, professional societies, online patient communities, healthcare provider), and security features including login/password protection and privacy policy statement. Apps were then rated using (with permission from originator) a published reliable and multidimensional scale: Mobile App Rating Scale (MARS). The study authors were trained on MARS using the recommended slides and exercise. In addition, quality of health information contained in informational apps was rated using the published DISCERN instrument. Results: The search terms SLE and Lupus retrieved a total of 471 apps on Google Play store and a total of 198 apps on Apple Store. On Google Play, 14/471 met our inclusion criteria compared to 11/198 on Apple Store. Majority of Google apps were in the tools category representing 44%, followed by apps that are both tools and informational (31%), whereas informational apps were 25%. On the other hand, majority of Apple Store apps were both tools and informational (64%), followed by tools only apps (27%), and finally informational only apps (9%). The most common apps features were email login (37%) and links to external sites including social media platforms (31%). Two apps were identified as a potential source for misleading information claiming that certain homemade herbs/food has anti-inflammatory properties to treat lupus. The average MARS score for Google apps was 2.7/5 indicating poor apps quality. The average MARS score for Apple apps was 3.7 indicating acceptable apps quality. Overall, the functionality score was the highest (3.9/5) while the engagement score was the lowest (2.7/5) for both app stores. For apps that contained information for patients, DISCERN score was 2.15/5 and 3.12/5 for Google and Apple apps respectively indicating potentially important shortcomings in the quality of health information provided in these apps. Conclusion: Our study demonstrates that a larger need is emerging for designing high-quality apps for patients with lupus. Healthcare organizations, professional societies, rheumatologists, and allied health professionals are encouraged to participate in promoting and creating high-quality apps for lupus patients. These apps are likely to contribute to improving the quality of care provided to these patients and can potentially extend care in the looming global shortage of rheumatologists. This is also an acknowledgement of the need to adapt to advancing communications technology as it integrates into many patients' lives in this digital age.