Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group
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Surgeon practice patterns for pre‑soaking ACL tendon grafts in vancomycin: a survey of the ACL study group Michelle Xiao1 · Seth L. Sherman1 · Marc R. Safran1 · Geoffrey D. Abrams1 Received: 14 July 2020 / Accepted: 28 August 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose To survey members of The ACL study group to determine the current practice patterns surrounding the technique of pre-soaking ACL grafts in vancomycin. Methods A web-based questionnaire was distributed to members of the ACL Study Group. Questions included the use of vancomycin solution for graft soaking during ACL reconstruction, their protocol for soaking the graft, vancomycin concentration utilized, graft choices, and concerns with the technique. Results Sixty-six (57%) ACL surgeons completed the survey. Approximately one-third (37.9%) of respondents currently pre-soak their ACL grafts in vancomycin prior to implantation, with 60% of these surgeons being from Europe. Seventy-six percent have adopted this practice within the past 5 years. The majority of surgeons wrap the graft in a vancomycin-soaked gauze prior to implantation (56%), soak for a variable amount of time before implantation (56%), use a concentration of 5 mg/mL (68%), and soak hamstring grafts (92%). Concerns included the mechanical properties of the graft (35%), cost of vancomycin (23%), availability (12%), and antibiotic resistance (9%). Conclusion This survey demonstrates that 37.9% of ACL study group members currently utilize vancomycin to pre-soak ACL tendon grafts as a means to decrease post-operative infection risk, with the majority of surgeons having implemented this practice within the past 5 years. The biggest concern towards using vancomycin was the mechanical properties of the graft after soaking. Level of evidence IV. Keywords ACL · Vancomycin · Survey · Infection
Introduction Anterior cruciate ligament (ACL) tears are a common orthopedic sports medicine injury, with an estimated incidence of 43.5 injuries per 100,000 person-years [18]. ACL reconstruction is important for restoring joint stability and returning patients back to pre-injury activity levels [21]. While post-operative infections are a rare occurrence, they can be a potentially devastating complication after surgery. Even Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-020-06265-1) contains supplementary material, which is available to authorized users. * Geoffrey D. Abrams [email protected] 1
Department of Orthopaedic Surgery, Stanford University School of Medicine, 341 Galvez St, Mail Code 6175, Stanford, CA 94305, USA
with standard administration of pre-operative intravenous (IV) antibiotic prophylaxis, the rate of infection after ACL surgery is estimated to be between 0.14% and 1.7% [3, 7, 11, 13, 15, 17, 19]. Post-operative infection and septic arthritis can lead to patient morbidity, graft failure, re-operations, decreased outcomes, and increased healthcare utilization
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