Abstract:Background:
Reported infection rates following anterior cruciate ligament (ACL) reconstruction are low, but infections are associated with high morbidity including reoperations and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with a vancomycin irrigant.
Methods:
All ACL reconstructions performed between May 2009 and August 2018 at a singl… Show more
“…While deep infection following ACLR is a devastating complication with high morbidity, there is a paucity of literature examining preventative strategies to limit postoperative infection. 4 , 30 , 31 Baron et al 13 observed a reduction in infection post-ACLR from 1.2% to 0.1% in a retrospective analysis of 1,640 patients with the use of vancomycin-soaked grafts. Similar studies by Vertullo et al 32 and Perez-Prieto et al 33 reported reductions in postoperative infection from 1.4% to 0% and from 1.9% to 0%, respectively.…”
Section: Discussionmentioning
confidence: 99%
“… 4 Multiple studies have shown that pre-soaking grafts in vancomycin may lead to decreased deep infection rates. 13 - 15 However, potential disadvantages of vancomycin include development of antibiotic-resistant organisms from overuse, graft toxicity, and increased cost compared to alternative agents. 16 Current literature has not reported any increased laxity, re-rupture rates, or worse short- and mid-term functional outcomes with vancomycin use.…”
Aims Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of hamstring grafts influences infection rates following ACLR. We set out to examine this in our study accordingly. Methods This retrospective study included 2,000 patients (1,156 males and 844 females) who underwent primary ACLR with hamstring autografts between 2007 to 2017. This included 1,063 patients who received pre-soaked saline hamstring grafts for ACLR followed by 937 patients who received pre-soaked gentamicin hamstring grafts for ACLR. All operative procedures were completed by a single surgeon using a standardized surgical technique. Medical notes were reviewed and data relating to the following outcomes recorded: postoperative infection, clinical progress, causative organisms, management received, and outcomes. Results Superficial wound infection developed in 14 patients (1.31 %) receiving pre-saline soaked hamstring grafts compared to 13 patients (1.38 %) receiving pre-gentamicin soaked hamstring grafts, and this finding was not statistically significant (p = 0.692). All superficial wound infections were treated with oral antibiotics with no further complications. There were no recorded cases of septic arthritis in patients receiving pre-gentamicin soaked grafts compared to nine patients (0.85%) receiving pre-saline soaked grafts, which was statistically significant (p = 0.004). Conclusion Pre-soaking hamstring autographs in gentamicin does not affect superficial infection rates but does reduce deep intra-articular infection rates compared to pre-soaking hamstring grafts in saline alone. These findings suggest that pre-soaking hamstring autografts in gentamicin provides an effective surgical technique for reducing intra-articular infection rates following ACLR. Cite this article: Bone Jt Open 2021;2(1):66–71.
“…While deep infection following ACLR is a devastating complication with high morbidity, there is a paucity of literature examining preventative strategies to limit postoperative infection. 4 , 30 , 31 Baron et al 13 observed a reduction in infection post-ACLR from 1.2% to 0.1% in a retrospective analysis of 1,640 patients with the use of vancomycin-soaked grafts. Similar studies by Vertullo et al 32 and Perez-Prieto et al 33 reported reductions in postoperative infection from 1.4% to 0% and from 1.9% to 0%, respectively.…”
Section: Discussionmentioning
confidence: 99%
“… 4 Multiple studies have shown that pre-soaking grafts in vancomycin may lead to decreased deep infection rates. 13 - 15 However, potential disadvantages of vancomycin include development of antibiotic-resistant organisms from overuse, graft toxicity, and increased cost compared to alternative agents. 16 Current literature has not reported any increased laxity, re-rupture rates, or worse short- and mid-term functional outcomes with vancomycin use.…”
Aims Graft infection following anterior cruciate ligament reconstruction (ACLR) may lead to septic arthritis requiring multiple irrigation and debridement procedures, staged revision operations, and prolonged courses of antibiotics. To our knowledge, there are no previous studies reporting on how gentamicin pre-soaking of hamstring grafts influences infection rates following ACLR. We set out to examine this in our study accordingly. Methods This retrospective study included 2,000 patients (1,156 males and 844 females) who underwent primary ACLR with hamstring autografts between 2007 to 2017. This included 1,063 patients who received pre-soaked saline hamstring grafts for ACLR followed by 937 patients who received pre-soaked gentamicin hamstring grafts for ACLR. All operative procedures were completed by a single surgeon using a standardized surgical technique. Medical notes were reviewed and data relating to the following outcomes recorded: postoperative infection, clinical progress, causative organisms, management received, and outcomes. Results Superficial wound infection developed in 14 patients (1.31 %) receiving pre-saline soaked hamstring grafts compared to 13 patients (1.38 %) receiving pre-gentamicin soaked hamstring grafts, and this finding was not statistically significant (p = 0.692). All superficial wound infections were treated with oral antibiotics with no further complications. There were no recorded cases of septic arthritis in patients receiving pre-gentamicin soaked grafts compared to nine patients (0.85%) receiving pre-saline soaked grafts, which was statistically significant (p = 0.004). Conclusion Pre-soaking hamstring autographs in gentamicin does not affect superficial infection rates but does reduce deep intra-articular infection rates compared to pre-soaking hamstring grafts in saline alone. These findings suggest that pre-soaking hamstring autografts in gentamicin provides an effective surgical technique for reducing intra-articular infection rates following ACLR. Cite this article: Bone Jt Open 2021;2(1):66–71.
“…9,16 Specifically, concentrations used to soak the ACL graft have ranged from 1 to 5 mg/mL. 4,22,31 To create the vancomycin solution, lyophilized vancomycin hydrochloride was directly dissolved into the cell culture media and serially diluted to produce 5 different concentrations (400, 1600, 3200, 6400, and 12,800 µg/mL). Tenocytes were exposed to vancomycin for either 2, 6, or 24 hours.…”
Section: Methodsmentioning
confidence: 99%
“…16,28 Recently, some have advocated for soaking ACL grafts in vancomycin solution before implantation, with most reports utilizing a concentration of 5 mg/mL. 4,22,25,31 The practice of surgical field antibiotic use has historically has been confined to spine procedures 18,29,30 and joint arthroplasties, 14,24,32 with the former demonstrating a reduced incidence of SSIs with application of topical vancomycin. 8,10,28,30 These procedures, however, are qualitatively different from sports medicine procedures, particularly ACL reconstruction, where biological incorporation and toxicity to local tissues is more of a concern.…”
Background: Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity because of tenocyte toxicity. Purpose: To examine the in vitro toxicity of varying doses of vancomycin on human tenocytes. Study Design: Controlled laboratory study. Methods: Human patellar tenocytes were isolated and expanded in vitro. Tenocytes in culture were exposed to vancomycin at 5 different concentrations (400, 1600, 3200, 6400, and 12,800 μg/mL) and 3 time intervals (2, 6, and 24 hours). The control for all series was tenocyte exposure to only culture medium for each time interval. After treatment, a 10% Cell Counting Kit-8 solution in cellular growth medium was applied to the cells to examine cytotoxicity. A live/dead assay was used to assess tenocyte viability through fluorescence microscopy and flow cytometry. Results were analyzed statistically using multivariable logistic regression models with Tukey honest significant difference post hoc tests. Results: Vancomycin did not cause significant changes in tenocyte viability after 2 and 6 hours of incubation at any concentration between 0 and 12,800 µg/mL. Incubation with vancomycin for 24 hours led to a significant decrease in cell viability at higher concentrations. Conclusion: Tenocytes derived from human patellar tendons exposed to relatively high concentrations of vancomycin for short periods of time do not demonstrate significant cell death and toxicity. Clinical Relevance: Exposing tendons to vancomycin for a short period of time, such as before ACL reconstruction, is not likely to cause tenocyte toxicity because of vancomycin administration.
“…Durch Einlegen des Transplantates in einer Vancomycin-Lösung Vancomycin-Lösung vor der Implantation wird das Infektionsrisiko signifikant verringert [ 31 ].…”
Zusammenfassung
Das vordere Kreuzband (VKB) ist gemeinsam mit dem hinteren Kreuzband ein zentraler Stabilisator des Kniegelenkes. Es stabilisiert die Tibia gegen eine vermehrte Translation nach ventral sowie gegen eine vermehrte Innenrotation. Mit einer Inzidenz von 46/100.000 zählen Risse des vorderen Kreuzbandes zu den häufigsten Sportverletzungen in Deutschland. Neue Präventionsprogramme können das Risiko einer Kreuzbandverletzung verringern. Bei jungen und sportlich aktiven Patienten wird die operative Behandlung empfohlen, wodurch auch das Risiko von relevanten Meniskus- und Knorpelverletzungen in der Folge verringert werden kann. Standard der operativen Therapie in Deutschland ist die vordere Kreuzbandersatzbandplastik mittels autologer Sehne. In ausgewählten Fällen zeigt der operative Erhalt des vorderen Kreuzbandes durch arthroskopische Refixation gute Ergebnisse. Anstelle der bisherigen rein zeitbasierten Rehabilitation werden zunehmend funktionsbasierte Kriterien in die Nachbehandlung mit einbezogen.
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