Does Vancomycin Wrapping in Anterior Cruciate Ligament Reconstruction Affect Tenocyte Activity In Vitro?

Abstract

Knee septic arthritis is a devastating complication following anterior cruciate ligament (ACL) reconstruction. To prevent this issue, intraoperative soaking of ACL grafts with vancomycin is often performed before implantation. Although vancomycin cytotoxicity has been reported several times, little is known about its biological effect on tenocytes. The aim of this study was to evaluate the in vitro effects of vancomycin on human primary tenocytes (hTCs). hTCs were isolated from hamstring grafts of four patients undergoing ACL reconstruction. After expansion, hTCs were treated with different concentrations of vancomycin (0, 2.5, 5, 10, 25, 50 and 100 mg/mL) for 10, 15, 30 and 60 min. In vitro cytotoxicity was evaluated measuring metabolic activity, cell toxicity, and apoptosis. hTC metabolic activity was affected starting from 10 mg/mL vancomycin and decreased markedly at 100 mg/mL. Cell viability remained unaffected only at a concentration of 2.5 mg/mL vancomycin. Vancomycin cytotoxicity was detected from 10 mg/mL after 15 min and at all higher concentrations. Cells died when treated with concentrations higher than 5 mg/mL. The use of this antibiotic on tendons to prevent infections could be useful and safe for resident cells if used at a concentration of 2.5 mg/mL for up to 1 h of treatment.

A Review of Evidence for Infection Reduction With Vancomycin-treated Anterior Cruciate Ligament Grafts

“…Xiao et al 31 exposed human patellar tenocytes to five different concentrations of vancomycin solution for three time durations and demonstrated no notable cell death or toxicity even in concentrations up to 12,800 μg/mL for 2- and 6-hour exposures. However, Papalia et al 32 investigated the effects of vancomycin on human tenocytes derived from hamstring grafts harvested from four patients during ACL reconstruction and measured in vitro effects on metabolic activity, cell toxicity, and apoptosis. The authors concluded that tenocytes remain unaffected at a concentration of 2.5 mg/mL and is safe for up to 1 hour, but cytotoxicity was detected with a 10 mg/mL solution after 15 minutes and at all higher concentrations.…”

Postoperative complications following ACL reconstruction: Prevention and management

“…After ACL surgery, 63-65% of patients return to sport, with 44-46% returning to competitive participation. [28] . Those who failed the six-month return-to-sport test showed altered contralateral hip strategy with restricted motion and attenuating forces about the damaged knee during locomotion.…”

Massive foreign body reaction and osteolysis following primary anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system (LARS): a case report with histopathological and physicochemical analysis

“…and prolonged rehabilitation. Nonetheless, autografts still remain the 'gold standard' in primary ACLR [3]. Therefore, a great interest towards the development of synthetic anterior cruciate ligament (ACL) grafts that may overcome such drawbacks has been raised in the last decades.…”