Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function

Abstract

Purpose To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking. Methods A case–control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1 « without vancomycin » before November 2016 and Group 2 « with vancomycin» after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated. Results 1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30 ± 9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p = 0.04). Knee function was comparable between the groups. Conclusion Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function. Level of evidence III. Trial registration https://clinicaltrials.gov/, ClinicalTrials.gov Identifier: NCT02511158

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

“…All the studies included in this systematic review were level III studies [2][3][4]8,20,[22][23][24][25]28,30]. Two studies reported on the same patient population, with the followup study including a larger number of patients in the treatment group (vancomycin) and the same control group of the former study [23,28].…”

“…Unfortunately, regarding infection, only 5 studies (4 m using only hamstring grafts) [2,8,23,28,30] reported the type of graft in infected patients, preventing the possibility of analyzing data on graft type differences. Three studies [3,4,28] included open procedures (collateral ligament repair/ reconstructions or extra-articular tenodesis) in the same surgical act as the ACL reconstruction.…”

“…Ten of the studies used a soaked gauze swab to deliver vancomycin to the graft; the majority of these studies also soaked the graft directly in the solution before covering the graft with the gauze swab. One study soaked the graft directly in the solution as the only method to deliver vancomycin [4]. Eight studies reported the duration of graft soaking (10 to 20 minutes).…”

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

“…Similarly, Jacquet et al 24 in a study using living donors found that presoaking of human semitendinosus grafts with vancomycin (5 mg/mL) does not alter their biomechanical properties at time zero. Until now, there have been no studies regarding long-term biomechanical effects of its use, however, Offerhaus et al 15 published a significant decrease of graft failure in patients with Vancomycin presoaked grafts and no increase in the rate of postoperative arthrofibrosis and subjective outcome scores compared to a control group without Vancomycin, and Bohu et al 20 found no differences in return to running and overall knee function with control patients. In addition, they found that more patients with Vancomycin presoaked grafts returned to their pre-injury sport compared to their control counterparts.…”

“…Bohu et al 20 conducted a study to compare return to sports and knee function one year after ACL reconstruction using autografts with and without Vancomycin presoaking. In this series, 79.3% of the patients were operated using a hamstring autograft.…”