Skip to main content
SpringerLink
Log in

Soaking of autografts in vancomycin is highly effective in preventing postoperative septic arthritis after revision anterior cruciate ligament reconstruction

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine and compare the incidence of postoperative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre series.

Methods

A total of 2155 isolated R-ACLR with autologous tendons were performed from 2004 to 2019 and were reviewed with regard to the occurrence of postoperative septic arthritis. From February 2017 onwards, all grafts were wrapped in a vancomycin-soaked (5 mg/ml) gauze swab between harvest and implantation (517 patients, treatment group (2), prospectively followed). These were compared to 1638 patients before that date (control group (1), retrospectively evaluated). The technique of R-ACLR did not significantly change during the years of the study. Hamstring tendons were used in 1310 patients (60.8%) and quadriceps tendons with patellar bone block were used in 845 patients (39.2%), respectively, with no difference between the groups (n.s.). Routine follow-up examination was performed 6 weeks postoperatively (follow-up rate 96.5%), and patients with no treatment for septic arthritis until that time were classified as non-infected.

Results

There were 14 cases of postoperative septic arthritis in group 1 (incidence 0.9%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p = 0.029).

Conclusion

Soaking of the graft in vancomycin solution prior to implantation dramatically reduces the incidence of postoperative septic arthritis in R-ACLR.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alomar AZ, Alfayez SM, Somily AM (2018) Hamstring autografts are associated with a high rate of contamination in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:1357–1361

    Article  Google Scholar 

  2. Bansal A, Lamplot JD, VandenBerg J, Brophy RH (2018) Meta-analysis of the risk of infections after anterior cruciate ligament reconstruction by graft type. Am J Sports Med 46:1500–1508

    Article  Google Scholar 

  3. Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV (2016) Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthroscopy 32:2556–2561

    Article  Google Scholar 

  4. Dodson V, Majmundar N, Swantic V, Assina R (2019) The effect of prophylactic vancomycin powder on infections following spinal surgeries: a systematic review. Neurosurg Focus 46:E11

    Article  Google Scholar 

  5. Eriksson K, Karlsson J (2016) Local vancomycin in ACL reconstruction: a modern rationale (2016) for morbidity prevention and patient safety. Knee Surg Sports Traumatol Arthrosc 24:2721–2723

    Article  Google Scholar 

  6. Gande A, Rosinski A, Cunningham T, Bhatia N, Lee YP (2019) Selection pressures of vancomycin powder use in spine surgery: a meta-analysis. Spine J 19:1076–1084

    Article  Google Scholar 

  7. Gowd AK, Liu JN, Bohl DD, Agarwalla A, Cabarcas BC, Manderle BJ, Garcia GH, Forsythe B, Verma NN (2019) Operative time as an independent and modifiable risk factor for short-term complications after knee arthroscopy. Arthroscopy 35:2089–2098

    Article  Google Scholar 

  8. Grayson JE, Grant GD, Dukie S, Vertullo CJ (2011) The in vitro elution characteristics of vancomycin from tendons. Clin Orthop Relat Res 469:2948–2952

    Article  Google Scholar 

  9. Hantes ME, Basdekis GK, Varitimidis SE, Giotikas D, Petinaki E, Malizos KN (2008) Autograft contamination during preparation for anterior cruciate ligament reconstruction. J Bone Joint Surg Am 90:760–764

    Article  Google Scholar 

  10. Hey HW, Thiam DW, Koh ZS, Thambiah JS, Kumar N, Lau LL, Liu KG, Wong HK (2017) Is intraoperative local vancomycin powder the answer to surgical site infections in spine surgery? Spine (Phila Pa 1976) 42:267–274

    Article  Google Scholar 

  11. Indelli PF, Dillingham M, Fanton G, Schurman DJ (2002) Septic arthritis in postoperative anterior cruciate ligament reconstruction. Clin Orthop Relat Res 398:182–188

    Article  Google Scholar 

  12. Maletis GB, Inacio MC, Funahashi TT (2013) Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med 41:2090–2098

    Article  Google Scholar 

  13. Maletis GB, Inacio MC, Reynolds S, Desmond JL, Maletis MM, Funahashi TT (2013) Incidence of postoperative anterior cruciate ligament reconstruction infections: graft choice makes a difference. Am J Sports Med 41:1780–1785

    Article  Google Scholar 

  14. Mouzopoulos G, Fotopoulos VC, Tzurbakis M (2009) Septic knee arthritis following ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 17:1033–1042

    Article  Google Scholar 

  15. Offerhaus C, Balke M, Hente J, Gehling M, Blendl S, Hoher J (2019) Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27:3014–3021

    Article  Google Scholar 

  16. Perez-Prieto D, Portillo ME, Torres-Claramunt R, Pelfort X, Hinarejos P, Monllau JC (2018) Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated. Knee Surg Sports Traumatol Arthrosc 26:558–562

    Article  Google Scholar 

  17. Perez-Prieto D, Torres-Claramunt R, Gelber PE, Shehata TM, Pelfort X, Monllau JC (2016) Autograft soaking in vancomycin reduces the risk of infection after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 24:2724–2728

    Article  Google Scholar 

  18. Phegan M, Grayson JE, Vertullo CJ (2016) No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts. Knee Surg Sports Traumatol Arthrosc 24:2729–2735

    Article  Google Scholar 

  19. Pogorzelski J, Themessl A, Achtnich A, Fritz EM, Wortler K, Imhoff AB, Beitzel K, Buchmann S (2018) Septic arthritis after anterior cruciate ligament reconstruction: how important is graft salvage? Am J Sports Med 46:2376–2383

    Article  Google Scholar 

  20. Schuster P, Gesslein M, Mayer P, Schlumberger M, Mayr R, Richter J (2018) Septic arthritis after arthroscopic posterior cruciate ligament and multi-ligament reconstructions is rare and can be successfully treated with arthroscopic irrigation and debridement: analysis of 866 reconstructions. Knee Surg Sports Traumatol Arthrosc 26:3029–3038

    Article  Google Scholar 

  21. Schuster P, Schulz M, Immendoerfer M, Mayer P, Schlumberger M, Richter J (2015) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: evaluation of an arthroscopic graft-retaining treatment protocol. Am J Sports Med 43:3005–3012

    Article  Google Scholar 

  22. Schuttler KF, Scharm A, Stein T, Heyse TJ, Lohoff M, Sommer F, Spiess-Naumann A, Efe T (2019) Biomechanical and microbiological effects of local vancomycin in anterior cruciate ligament (ACL) reconstruction: a porcine tendon model. Arch Orthop Trauma Surg 139:73–78

    Article  Google Scholar 

  23. Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA (2016) Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 44:3083–3094

    Article  Google Scholar 

  24. Torres-Claramunt R, Pelfort X, Erquicia J, Gil-Gonzalez S, Gelber PE, Puig L, Monllau JC (2013) Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc 21:2844–2849

    Article  CAS  Google Scholar 

  25. Van Tongel A, Stuyck J, Bellemans J, Vandenneucker H (2007) Septic arthritis after arthroscopic anterior cruciate ligament reconstruction: a retrospective analysis of incidence, management and outcome. Am J Sports Med 35:1059–1063

    Article  Google Scholar 

  26. Vertullo CJ, Quick M, Jones A, Grayson JE (2012) A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy 28:337–342

    Article  Google Scholar 

  27. Wang C, Lee YH, Siebold R (2014) Recommendations for the management of septic arthritis after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 22:2136–2144

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre for Arthroscopy and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany

    Philipp Schuster, Michael Schlumberger, Philipp Mayer, Martin Eichinger & Jörg Richter

  2. Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Nuremberg, Germany

    Philipp Schuster & Markus Geßlein

  3. Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

    Michael Schlumberger & Martin Eichinger

Authors
  1. Philipp Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Schlumberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Eichinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Markus Geßlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jörg Richter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Schuster.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the competent Ethical committee.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Investigation performed at the Centre for Sports Orthopedics and special joint surgery, Orthopedic Hospital Markgroeningen, Germany.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schuster, P., Schlumberger, M., Mayer, P. et al. Soaking of autografts in vancomycin is highly effective in preventing postoperative septic arthritis after revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 28, 1154–1158 (2020). https://doi.org/10.1007/s00167-019-05820-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05820-9

Keywords

Search

Navigation