A Surgical Technique Using Presoaked Vancomycin Hamstring Grafts to Decrease the Risk of Infection After Anterior Cruciate Ligament Reconstruction

Vertullo, Christopher J.; Quick, Mark; Jones, A. S.; Grayson, Jane

doi:10.1016/j.arthro.2011.08.301

Cited by 109 publications

(147 citation statements)

References 33 publications

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“…For this reason, reducing morbidity after ACL reconstructive procedures must be a significant part of the "ACL holy grail".The incidence of deep post-operative infection following an ACL reconstruction varies between 0.14 and 1.7 % in different studies [2,12]. The majority of the present studies report an incidence of just below 1 %.…”

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confidence: 81%

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Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Eriksson

Karlsson

2016

Knee Surg Sports Traumatol Arthrosc

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treatment has become the first line of treatment unless contraindicated.It is obvious that, with improved results in both the short and long term [function and risk of osteoarthritis (OA)] and a simultaneous reduced risk of complications and morbidity related to the procedure, more people could benefit from surgery. For this reason, reducing morbidity after ACL reconstructive procedures must be a significant part of the "ACL holy grail".The incidence of deep post-operative infection following an ACL reconstruction varies between 0.14 and 1.7 % in different studies [2,12]. The majority of the present studies report an incidence of just below 1 %. Moreover, there are some signs that hamstring grafts are slightly more likely to be infected compared with patellar tendon (BTB) grafts. In terms of pathogens, coagulase-negative staphylococcus (CNS) appears to be the dominant species, followed by staphylococcus aureus and propionebacterium acne. The most likely aetiology is graft contamination from the patient's own skin flora.The potential consequences of a deep infection can obviously be devastating, with the need for graft and hardware removal, and in many patients, a second stage ACL-R 4 to 6 months later. However, in most cases, repeated washouts and long-term antibiotics cure the infection, and the graft may survive. The two major concerns following deep infection after ACL-R are graft survival and long-term graft function, but also the increased likelihood of long-term OA. In a recent publication by Boström Windhamre et al. [1], 27 of 43 reported infected ACL-Rs were compared with matched controls in terms of activity, time to recovery and knee function. The infection rate was estimated at 0.98 %.The recovery time was significantly longer, and the Tegner activity level was lower, while the KOOS values at a mean of 60 months post-operatively revealed no ACL reconstruction (ACL-R) in 2016 still faces two major challenges. The first is to improve the surgical technique and consequently the overall results, and the second is to minimise the morbidity of the procedure. The fact is that, if significant improvements in both these areas can be achieved, we would most probably offer surgical treatment (repair or reconstruction) as the first line of treatment to most young and middle-aged patients sustaining an ACL rupture. This argument could be compared with tibial fractures or other traumatic conditions, where surgical

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confidence: 81%

“…The local administration of vancomycin to the graft was first presented by Vertullo et al in 2012, in a study in which they reported a 0 % infection rate in a prospective series compared with 1.4 % in a retrospective control population [12]. All the patients in both cohorts were operated on by the same surgeon.…”

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confidence: 99%

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Eriksson

Karlsson

2016

Knee Surg Sports Traumatol Arthrosc

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“…With regard to new prophylactic measures described to decrease infection rate following ACLR, recent investigations demonstrated that presoaking the autograft in a diluted solution of vancomycin is effective for this purpose [24][25][26]. Other measures, such as the use of gentamicin irrigation solution, have been shown as less effective [27].…”

Section: Aetiopathologymentioning

confidence: 97%

Managing septic arthritis after knee ligament reconstruction

Torres-Claramunt

Gelber

Pelfort

et al. 2015

International Orthopaedics (SICOT)

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“…More collagen for your graft! • Keep the graft in a sterile gauze soaked in 5 mg/mL vancomycin solution to reduce your infection rate [ 36 ].…”

Section: Pearls and Tricksmentioning

confidence: 99%

Graft Harvest and Preparation

Monllau

Petersen

Fink³

et al. 2014

Anterior Cruciate Ligament Reconstruction

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Among the various surgical procedures for correcting knee instability after ACL injury, the standard method of treatment is intra-articular ACL reconstruction with autogenous tissues. The bone-patellar tendon-bone autograft had been traditionally considered as the gold-standard surgical option. However, in an effort to minimize the donor-site morbidity associated to its harvest, semitendinosus tendon (ST) and gracilis tendon (GT) are increasingly used for ACL reconstruction. The doubled ST and GT grafts have greater mechanical strength than a bone-patellar tendonbone complex [ 22 ], and the donor-site morbidity

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A Surgical Technique Using Presoaked Vancomycin Hamstring Grafts to Decrease the Risk of Infection After Anterior Cruciate Ligament Reconstruction

Cited by 109 publications

References 33 publications

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety

Managing septic arthritis after knee ligament reconstruction

Graft Harvest and Preparation

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