Biomechanical and microbiological effects of local vancomycin in anterior cruciate ligament (ACL) reconstruction: a porcine tendon model

Schüttler, Karl F.; Scharm, Alexander; Stein, Thomas; Heyse, Thomas J.; Lohoff, Michael; Sommer, Frank; Spiess-Naumann, Anja; Efe, Turgay

doi:10.1007/s00402-018-3006-x

Cited by 38 publications

(39 citation statements)

References 19 publications

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“…However, Domnick et al could demonstrate that for biomechanical investigations, fresh-frozen porcine flexor tendons represent an appropriate substitute for human semitendinosus tendons [20]. Both porcine flexor tendons and the mechanical setup in this study have been used in other investigations on the strength of suture-tendon constructs [12,[20][21][22][23]. Freezing the samples for storage might have influenced the material properties, but the tensile force gets lower because of freezing [20].…”

Section: Discussionmentioning

confidence: 92%

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The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

Theopold¹,

Schleifenbaum

Georgi³

et al. 2020

Arch Orthop Trauma Surg

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Purpose Numerous techniques have been described for the tibial-sided graft preparation in anterior cruciate ligament (ACL) reconstruction. The use of less suture material for graft preparation is thought to improve ingrowth and to reduce the risk for infection. At the same time, the suture construct should be strong enough to resist the surgeon's pull during tensioning of the transplant. Methods In total, 39 fresh-frozen procine deep flexor tendons were used and prepared as four-strand grafts. In the three-suture group (n = 19), graft preparation was performed using three tibial-sided sutures, with each tendon end sutured separately. In the one-suture group (n = 20), a modified graft preparation using only one tibial-sided suture was applied. Each sample underwent load-to-failure testing (N max ) after cyclic pre-loading. To estimate intraoperative tension forces acting on the tibial-sided suture constructs, the maximal tension force of 26 volunteers on such a construct was measured using a load cell. Results The biomechanical testing of the two different suture constructs showed a significantly higher load-to-failure for the three-suture group (711 N ± 91 N) compared to the one-suture group (347 N ± 24 N) (p = 0.0001). In both groups, the mode of failure was a tear of the suture in all samples. A failure of the suture-tendon interface was not observed in any case. The median maximal tension force on the construct applied by the 26 volunteers was 134 N (range 73-182 N). Conclusion The presented single-suture tendon graft preparation resisted to smaller failure loads than the conventional three-suture technique. However, no failures in the suture-tendon interface were seen and the failure loads observed were far beyond the tension forces that can be expected intraoperatively. Hence, the single-suture graft preparation technique may be a valuable alternative to the conventional technique.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 92%

“…The samples were thawed to room temperature for 12 h before the testing and cut to a length of 24 cm. Fresh-frozen porcine flexor tendons were used based on availability and comparable biomechanical properties compared to human tendons [20] and they had been established for similar testing setups in previous studies [21][22][23].…”

Section: Samplesmentioning

confidence: 99%

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

Theopold¹,

Schleifenbaum

Georgi³

et al. 2020

Arch Orthop Trauma Surg

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“…Some in vitro studies have shown significant efficacy of vancomycin pre-soaking to eradicate bacteria in cases of septic arthritis post anterior cruciate ligament reconstruction 14,17 .…”

Section: Discussionmentioning

confidence: 99%

“…In their animal study on staphylococcus epidermidis infected tendons, Schuttler et al 14 demonstrated that pre-soaking for 20 minutes with high concentration vancomycin solution (5mg/ml) reduced bacterial growth after 7 days of culture from 85.7% to 0%.…”

Section: Discussionmentioning

confidence: 99%

“…Vancomycin seems to be an ideal choice for prophylactic antibiosis when used topically. It demonstrates a low rate of bacterial resistance on gram positive bacteria 11 and has low toxicity on local tissues 12,13 , Only one animal study in the literature has evaluated the impact of pre-soaking tendons with vancomycin and the possible consequences on their mechanical properties 14 . The immediate impact on the biomechanical properties by pre-soaking human ligament autografts with vancomycin has not been not been studied thus far.…”

Section: Introductionmentioning

confidence: 99%

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Presoaking of Semitendinosus Graft With Vancomycin Does Not Alter Its Biomechanical Properties: A Biomechanical In Vitro–Controlled Study Using Graft From Living Donors

Jacquet

Jaubert

Pioger

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

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Presoaking hamstring autograft with vancomycin does not jeopardize its biomechanical properties, including graft elongation, after cyclic loading

Park,

Yoon,

Kang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposePresoaking the graft with vancomycin before implantation has been shown to reduce the risk of postoperative infection after anterior cruciate ligament reconstruction (ACLR). However, the effects of presoaking on the graft biomechanical properties remain unclear. This study aimed to determine whether presoaking the graft with vancomycin affects the graft biomechanical properties and length after cyclic loading.MethodsTen paired (20 specimens) gracilis and semitendinous tendons were harvested from fresh‐frozen human cadaveric specimens. Two tendons were folded in half to make four strands, and the grafts were randomized into the vancomycin and control groups. The graft was exposed to the antibiotic solution for 15 min (5 mg/mL) and prepared by mixing 1 g of vancomycin with 200 mL of normal saline (NaCl 0.9%). The control group was soaked in normal saline for 15 min. The prepared grafts were attached to the actuator of a dynamic tensile‐testing machine. All grafts were tested with 3000 cycles of cyclic loading followed by a pull‐to‐failure. The cyclic loading protocol consisted of position and load control blocks to simulate the graft in vivo in the postoperative phase after ACLR.ResultsPresoaking in vancomycin did not jeopardize the biomechanical properties of the graft. In addition, presoaking with vancomycin did not elongate the grafts. No significant differences were found in the mean Young's modulus and the mean total elongation of the graft of the specimen between the vancomycin group and the control group.ConclusionPresoaking the graft with vancomycin jeopardized neither its biomechanical properties nor elongation even after cyclic loading in this in vitro study. It is suggested that vancomycin presoaking could be considered a safe and effective preventive measure for postoperative infections after ACLR.Level of EvidenceNot applicable.

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Biomechanical and microbiological effects of local vancomycin in anterior cruciate ligament (ACL) reconstruction: a porcine tendon model

Cited by 38 publications

References 19 publications

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

Presoaking of Semitendinosus Graft With Vancomycin Does Not Alter Its Biomechanical Properties: A Biomechanical In Vitro–Controlled Study Using Graft From Living Donors

Presoaking hamstring autograft with vancomycin does not jeopardize its biomechanical properties, including graft elongation, after cyclic loading

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