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Contaminated ACL grafts OK to implant after cleansing

Most surgeons responding to a hypothetical situation said they would clean a contaminated graft and proceed with surgery.

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If properly cleansed, surgeons can safely implant contaminated autografts into patients undergoing ACL reconstruction, according to a survey of sports medicine specialists.

Christopher S. Ahmad, MD, an assistant professor of orthopedic surgery at Columbia University in New York City, conducted the study with colleagues at the university and at several other centers in the United States. The researchers mailed a questionnaire to 337 sports medicine fellowship program directors and graduates of accelerated programs. This questionnaire sought data on the incidence of ACL graft contamination as well as treatment preferences and clinical outcomes, according to the study.

Twelve of the 337 questionnaires were returned to the sender. Of the remaining 325 questionnaires, 196 surgeons responded, yielding a 60% response rate.

These surgeons used a variety of ACL graft types and performed varying numbers of ACL reconstructions annually. Of the 196 respondents, 102 (52%) performed 40 to 100 reconstructions per year, 47 (24%) performed over 100 reconstructions, 45 (23%) performed between 10 and 40 reconstructions and two (1%) performed fewer than 10 reconstructions, according to the study.

Overall, 49 (25%) surgeons reported 57 cases of intraoperative graft contamination caused by graft contact with the floor or a nonsterile object. However, 35 surgeons (71%) — accounting for 43 of the 57 (75%) contaminated grafts — reported that they cleansed the graft intraoperatively and continued surgery.

“Of the 43 contaminated grafts that were cleansed and used, none developed postoperative complications consistent with infection,� the authors said in the study.

Surgeons reported using a variety of graft cleansing methods. Soaking in Hibiclens (4% chlorhexidine gluconate, Regent Medical) was most common and was used in 13 of the 43 (30%) contamination cases, according to the study.

Among the remaining 14 graft contamination cases, surgeons used an alternative autologous graft in 10 patients and used an alternative allograft in four patients.

The investigators also asked surgeons who did not experience graft contamination to hypothetically state how they would manage such situations; 65 surgeons responded to this question. Thirty-eight surgeons (58%) said they would cleanse the graft and proceed with surgery, 22 surgeons (34%) said they would use a different autograft and five surgeons (8%) said they would use an allograft, according to the study.

For more information:

• Izquierdo R, Cadet ER, Bauer R, et al. A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts. Arthroscopy. 2005;21:1348-1353.