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

Jacquet, Christophe; Jaubert, Maxime; Pioger, Charles; Sbihi, A.; Pithioux, Martine; Baron, Marie Le; Sharma, Ajay; Ollivier, Matthieu

doi:10.1016/j.arthro.2020.03.037

Cited by 21 publications

(22 citation statements)

References 28 publications

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“…Our initial elution in vitro studies of vancomycin from bovine tendons suggested a 5 mg/mL soak solution for 15 minutes would achieve adequate levels of vancomycin to decontaminate the graft while not being at risk of causing secondary tissue damage due to prolong elution. 4 Subsequent time zero studies have confirmed that 5 mg/mL is an appropriate concentration [5][6][7][8] to avoid injury to tenocytes chondrocytes and not alter the grafts material properties. Our initial and subsequent observational clinical series was supportive of our "colonized graft-infected joint" hypothesis, finding no infections when using the "vancomycin wrap" compared with a historical cohort with either similar or reduced rates of graft failure.…”

Section: See Related Article On Page 1683mentioning

confidence: 99%

Editorial Commentary: Is It Time for the Vancomycin Wrap to Become a Universal Recommendation for the Prevention of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction?

Vertullo

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Septic arthritis is a devastating complication of anterior cruciate ligament (ACL) reconstruction, which can still occur in approximately 1% of patients despite appropriate intravenous antibiotic prophylaxis and other recommended preventative measures being undertaken. The infection is most likely secondary to the autograft becoming contaminated during harvest and preparation, introducing bacteria into the joint on insertion. Presoaking ACL grafts in 5 mg/mL vancomycin is a novel method developed to eradicate this bacterial contamination and is supported by compelling Level III evidence from multiple observational trials showing a dramatic reduction in infection rates without any evidence of increased graft failure. As such, it is time for this technique to become a universal recommendation? That said, as observational studies using a historical cohort as a comparator are at risk of various biases, Level I evidence is ultimately required for infection prophylaxis methods to be recognized as a universal recommendation in infection control guidelines. Consequently, future research endeavors on the "vancomycin wrap" should focus on randomized controlled trials, possibly nested within ACL registries.

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Section: See Related Article On Page 1683mentioning

confidence: 99%

Editorial Commentary: Is It Time for the Vancomycin Wrap to Become a Universal Recommendation for the Prevention of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction?

Vertullo

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Mechanical testing determined the stress-strain curve, Young's modulus, ultimate tensile stress, ultimate tensile elongation (UTE) before failure and elastic limit. No significant difference was observed between the 2 groups for all investigated parameters 16 .…”

Section: Experimental Studiesmentioning

confidence: 70%

“…Data has not reported any adverse effects, such as graft degeneration, increased laxity, or a change in functional outcome at short-to medium-term follow-up 16,30,31 . Experience from spinal surgery has not shown any negative consequences from vancomycin use 17,32 .…”

Section: Lack Of Toxicitymentioning

confidence: 99%

The role of vancomycin-soaking of the graft in anterior cruciate ligament reconstruction

Rodríguez-Merchán¹,

Ribbans²

2022

Journal of ISAKOS

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…After soaking, the tendons showed no signs of biomechanical impairment. Similarly, Jacquet et al [13] in a study using living donors found that presoaking of human semitendinosus grafts with vancomycin (5 mg/mL) in a solution does not alter their biomechanical properties at time zero compared with a control group presoaked in saline solution.…”

Section: Discussionmentioning

confidence: 92%

Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

Figueroa

Calvo

et al. 2021

HSS Journal®

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Background: Vancomycin presoaking of the graft has been shown to decrease infection rates in some case series of anterior cruciate ligament (ACL) reconstruction. Purpose: We sought to substantiate the efficacy of vancomycin presoaked grafts for the prevention of infection after ACL reconstruction. Methods: We performed a systematic review of Medline and OVID to assess the incidence of postoperative infection in studies comparing patients undergoing ACL reconstruction with the use of vancomycin presoaked ACL grafts and a control group of patients undergoing ACL reconstruction without the use of presoaked grafts. The efficacy of vancomycin presoaking was calculated using the Agresti-Coull confidence interval. Relative risk (RR) was calculated for every study and the total sample. Results: The 11 studies that met inclusion criteria comprised 24,298 patients. In patients with vancomycin presoaking of the graft, 1 infection was reported in 8764 cases (0.01% rate). In the studies with control groups that did not have vancomycin presoaked grafts, there were 125 infections in 15,534 ACL reconstructions (0.8% rate). The efficacy of vancomycin presoaking in preventing infection after ACL reconstruction was 99.9% (0.999%–1.000% CI). The overall RR obtained was 0.07 (0.03–0.16 CI). All included studies were retrospective cohort studies (level III). Conclusions: Vancomycin presoaking of the graft has been shown to decrease infection rates after ACL reconstruction in studies of low evidence level. This suggests the need for prospective randomized controlled trials addressing this issue so that recommendations on the routine use of vancomycin presoaking of ACL grafts can be made with confidence.

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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

Cited by 21 publications

References 28 publications

Editorial Commentary: Is It Time for the Vancomycin Wrap to Become a Universal Recommendation for the Prevention of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction?

Editorial Commentary: Is It Time for the Vancomycin Wrap to Become a Universal Recommendation for the Prevention of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction?

The role of vancomycin-soaking of the graft in anterior cruciate ligament reconstruction

Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

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