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Category: Volume 08 Issue 09 September 2020
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Title: Does Presoaking of Autografts in Vancomycin Reduces the risk of Infection After ACL Reconstruction (?):  A Retrospective Study

Authors: Bijayendra Nath Chaturvedi, Omprakash Bhimwal, Shikha Dhaundiyal, Davinder Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v8i9.28

Abstract

Background: infections in ACL reconstruction surgery varies from frank septic arthritis to mild discharge at site of tibial tunnel. Since it is devastating complication both for patient as well as surgeon, and autografts are a frequent source of infection. To prevent this complication, a retrospective study was carried out by pre-soaking of autografts in Vancomycin to reduce the risk of infection.

Purpose: Purpose of this study is to determine whether the presoaking of an anterior cruciate ligament (ACL) autograft in Vancomycin reduces the rate of infection following an ACL reconstruction or not.

Materials and Methods: A retrospective study of 1836 patients that consecutively underwent primary arthroscopic ACL Reconstructions with four stranded single bundle Hamstrings autograft over four years at our institute was performed. In the initial 2 years period, the patients 963 patients received preoperative IV antibiotics (group 1). In the following 2 years period, 873 patients received preoperative IV antibiotics along with the graft was presoaked in a vancomycin solution (group 2). Presoaking was performed with sterile gauze previously saturated with a vancomycin solution (5 mg/ml).

Results: There were 963 and 873 patients in group 1 and 2, respectively. Eighteen cases of joint infections were identified in the series (0.98%). All of these infections occurred in group 1, representing a rate of infection of 1.86 % in comparison with 0 % in group 2 (p < 0.001).

Conclusions: Presoaking of autograft with vancomycin in combination with perioperative intravenous antibiotic prophylaxis reduced the rate of knee joint infection following an ACL Reconstruction in comparison with perioperative i.v antibiotic prophylaxis alone. This technique could be of relevance in daily clinical practice to prevent infection after ACLR.

Study Design: Case control & Retrospective comparative study; Level of evidence, 3.

Keywords: Vancomycin, Anterior cruciate ligament, pre-soaking, septic arthritis, Antibiotic prophylaxis, Biofilm.

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Corresponding Author

Dr Bijayendra Nath Chaturvedi

Senior Resident (Orthopaedics), Sports Injury Center (SIC, Ortho), VMMC & Safdarjung Hospital, New Delhi, India