Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review

Abstract

Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059

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

“…According to Figueroa 39 , the use of HT autografts has been related to an increased risk of infection following ACLR compared to other graft types. The reason for this is not clear, although contamination following harvesting and graft preparation is the most probable cause.…”

Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital

“…However, discrepancies among different studies as well as the dearth of prospective randomized control trials make it untimely to advise generalization of this procedure. 29 …”

Vancomycin-soaked femoral head allograft in opening wedge high tibia osteotomy enables earlier postoperative recovery and reduces infection rates compared to allogenic bone chips

“…Offerhaus et al [21] demonstrated significant reduction in superficial and deep infection using vancomycin pre‐soaked autografts for ACL reconstruction with no compromise in graft quality. Vancomycin is an ideal antibiotic agent due to its pharmacokinetic properties [4, 6, 18]. Vancomycin is a heat stable and water‐soluble antibiotic with a high volume of distribution [4].…”

“…Other than providing structure support, allografts can be an effective reservoir for local antibiotic delivery. Within literature, local administration of vancomycin has aided to reduce infection rates and wound complications in spine surgery, ligament reconstruction as well as arthroplasty [4, 6, 18, 21, 22]. During anterior cruciate ligament (ACL) reconstruction, pre‐soaking the grafts in vancomycin solution is a critical step in reducing graft‐related infections [4, 22].…”