Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated

Pérez-Prieto, Daniel; Portillo, María Eugenia; Torres-Claramunt, Raúl; Pelfort, Xavier; Hinarejos, Pedro; Monllau, Joan Carles

doi:10.1007/s00167-017-4735-z

Cited by 57 publications

(65 citation statements)

References 31 publications

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“…It also is important to note that contamination does not always lead to infection . No patient infections or incidents of septic arthritis were reported in these studies despite the contamination rates of the tissue.…”

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 77%

“…Currently, the research shows that the contamination levels of ACL grafts on the sterile field range from 12% to 22%, but researchers do not yet understand what causes the contamination (eg, skin flora, extensive preparation, airborne contaminates) . It also is important to note that contamination does not always lead to infection . No patient infections or incidents of septic arthritis were reported in these studies despite the contamination rates of the tissue.…”

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 91%

“… inspecting instruments with lumens used to harvest the hamstring for bioburden; covering the area of the sterile table where the graft will be prepared until use; changing gloves before handling the graft (eg, preparation, implantation); moving the sterile table with the graft preparation site within the unidirectional ultraclean air delivery system air curtain; considering using sponges soaked in antibiotic solutions or antiseptic solutions to keep the graft moist after preparation; covering the prepared and wrapped graft in a sealed container or with a drape until implantation; and covering the patient's skin in the area where the graft might make contact during implantation. …”

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 99%

“…More research is needed to determine the sources of ACL graft contamination and effective interventions to prevent contamination. Currently, the research shows that the contamination levels of ACL grafts on the sterile field range from 12% to 22%, but researchers do not yet understand what causes the contamination (eg, skin flora, extensive preparation, airborne contaminates) . It also is important to note that contamination does not always lead to infection .…”

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 99%

“… removing any sutures from the graft and disposing of them before decontamination; using a separate sterile field for decontamination of the tissue to prevent contamination of the main sterile field from splash or splatter during decontamination; immersing the graft in 500 mg of vancomycin powder mixed with 100 mL of sterile normal saline solution, then wrapping the graft in gauze saturated with the mixture until it is used; or soaking the graft in a solution of 50,000 units of bacitracin mixed with 1 L of normal saline solution for three minutes; changing gown and gloves after decontamination is complete; and conducting a debriefing session with the team members involved to determine the root cause of the event and interventions to prevent another occurrence …”

Section: Decontamination Of Contaminated Anterior Cruciate Ligament Gmentioning

confidence: 99%

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Clinical Issues—December 2019

Cahn¹

2019

AORN Journal

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Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 77%

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 91%

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 99%

Section: Preventing Anterior Cruciate Ligament Graft Contaminationmentioning

confidence: 99%

Section: Decontamination Of Contaminated Anterior Cruciate Ligament Gmentioning

confidence: 99%

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Clinical Issues—December 2019

Cahn¹

2019

AORN Journal

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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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