Vancomycin-soaked grafts may reduce infection rates after ACL reconstruction
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Intraoperative preparation with vancomycin-soaked grafts was linked with reduced infection rates in patients who underwent ACL reconstruction, according to presented results.
Jacqueline E. Baron, MD, of the department of orthopedics and rehabilitation at the University of Iowa, presented findings of a retrospective study on vancomycin irrigants at the American Orthopaedic Society for Sports Medicine Annual Meeting, which was held virtually.
“Infection rates following anterior cruciate ligament reconstruction range from 0.14% to 1.7%. Septic arthritis from infections is associated with high morbidity, and infections may result in worse clinical outcomes. Intraoperative graft contamination of skin flora may contribute to postoperative infection,” Baron said in her presentation. “Therefore, local antibiotic application may increase graft antibiotic levels above the minimum inhibitory concentration for common bacteria, such as staphylococcal and streptococcal species,” she added.
Baron and colleagues analyzed 1,640 primary or revision ACL reconstructions performed between May 2009 and August 2018. They defined infection as a return to the OR for incision and drainage within 90 days of the procedure.
“Grafts were soaked in 500 mL of 1-mg/mL solution of vancomycin for 10 minutes,” Baron said. “There were 798 patients (48.7%) who received a vancomycin presoaked graft vs. 842 patients (51.3%) who received a graft that was not soaked in vancomycin.”
Of the 1,640 cases, there were 11 infections (0.7% infection rate). Ten infections (1.2%) occurred without vancomycin grafts and one occurred with a vancomycin graft (0.1%).
“Increased BMI and increased operating time were associated with increased infection,” Baron said. “Remarkably, the utilization of a vancomycin pre-soaked graft remained associated with decreased infections following ACL reconstruction for all individual variables under study,” she added.
“Additionally, there were no cases of synovitis, stiffness or early graft failure secondary to vancomycin use,” Baron concluded.
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Baron JE, et al. ePoster 224. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
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