Philipp Schuster1,2, Michael Schlumberger3,4, Philipp Mayer3, Martin Eichinger3, Markus Geßlein5, Friederike Reddemann5, Jörg Richter3. 1. Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany. philipp_schuster@gmx.de. 2. Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Nuremberg, Germany. philipp_schuster@gmx.de. 3. Centre for Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany. 4. Department of Trauma Surgery, University Hospital Innsbruck, Innsbruck, Austria. 5. Clinic Nuremberg, Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Nuremberg, Germany.
Abstract
PURPOSE: To determine and compare the incidence of postoperative septic arthritis following anterior cruciate ligament reconstruction (ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre case series. METHODS: From 2004 to 2019, a total of 10,516 primary ACLR were performed and 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 (2294 patients, treatment group (2), prospectively followed). These were compared to 8222 patients before that date (control group (1), retrospectively evaluated). The technique of ACLR did not significantly change during the years of the study. There was no difference between the groups with regard to graft choice: Hamstring tendons were used in 99% and quadriceps tendons were used in 1% in both groups, respectively (n.s.). Routine follow-up examination was performed at 6 weeks (follow-up rate 97.1%) postoperatively. Patients with no treatment for septic arthritis at that time were classified as non-infected. RESULTS: There were 35 cases of postoperative septic arthritis in group 1 (incidence: 0.4%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p < 0.001). CONCLUSIONS: Soaking of the graft in vancomycin solution prior to implantation dramatically reduces the incidence of postoperative septic arthritis in primary ACLR and should, therefore, be used in prevention of this major complication. LEVEL OF EVIDENCE: III.
PURPOSE: To determine and compare the incidence of postoperative septic arthritis following anterior cruciate ligament reconstruction (ACLR) with and without soaking of the graft in vancomycin solution prior to implantation in a large single-centre case series. METHODS: From 2004 to 2019, a total of 10,516 primary ACLR were performed and 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 (2294 patients, treatment group (2), prospectively followed). These were compared to 8222 patients before that date (control group (1), retrospectively evaluated). The technique of ACLR did not significantly change during the years of the study. There was no difference between the groups with regard to graft choice: Hamstring tendons were used in 99% and quadriceps tendons were used in 1% in both groups, respectively (n.s.). Routine follow-up examination was performed at 6 weeks (follow-up rate 97.1%) postoperatively. Patients with no treatment for septic arthritis at that time were classified as non-infected. RESULTS: There were 35 cases of postoperative septic arthritis in group 1 (incidence: 0.4%), and none in group 2 (incidence 0.0%), respectively. The difference was significant (p < 0.001). CONCLUSIONS: Soaking of the graft in vancomycin solution prior to implantation dramatically reduces the incidence of postoperative septic arthritis in primary ACLR and should, therefore, be used in prevention of this major complication. LEVEL OF EVIDENCE: III.
Authors: I Geethan; Raju Easwaran; Santhosh Sahanand; Arumugam Sivaraman; Arun Gupta; Ashish Devgan; S Ashok; V B Bhasin; Clement Joseph; Deepak Chaudhary; Dinshaw N Pardiwala; P Gopinathan; John Thayyil John; J Maheshwari; Manabendra Nath Basumallick; Nicholas Antao; Nishith Shah; Palanivel Rajan; Parag Sancheti; Paresh Chandra Dey; Prakash Ayyadurai; Prateek Kr Gupta; K Raghuveer Reddy; Ravi Gupta; Ravi Mittal; Sachin Tapasvi; Schiller Thekekara Jos; Skand Sinha; S R Sundararajan; Vinod Kumar; Vivek Pandey; David V Rajan Journal: Indian J Orthop Date: 2021-02-01 Impact factor: 1.251