EC Orthopaedics

Background: Post-operative infection after the ACL reconstruction (ACLR) is a potentially devastating post-operative complication. The patient presents with knee sepsis, pain, effusion, redness, erythema, a rise in C-reactive protein, and an increased white blood cell count. Early recognition and treatment are vital. However, prophylactic treatments can work wonders in preventing or decreasing the mortality rates associated with sepsis. This study was conducted to determine if using a vancomycin-soaked hamstring graft during ACLR can reduce the risk of post-operative infection compared to traditional prophylactic antibiotics.

Methods: A retrospective comparative study of 295 consecutive patients who had undergone ACLR within 4 years to demonstrate the effectiveness of vancomycin-soaked hamstring autograft on lowering post-operative infection versus traditional prophylactic IV antibiotics only. The patients were divided into two groups depending on pre-soaked vancomycin hamstring autograft. Both groups received pre-operative prophylactic IV antibiotics, but only group 2 (n = 60) underwent ACLR with autografts pre-soaked in 500 mL of 1-mg/mL solution of vancomycin for an average of 20 - 30 minutes. The ACLR procedures were performed by 4 sports medicine fellowship-trained orthopedic surgeons, and only one surgeon used pre-soaked vancomycin hamstring autografts (supportive for using the method of a vancomycin-soaked hamstring graft during ACL). The other three surgeons used a traditional prophylactic antibiotic only (Not supportive of using the method of a vancomycin-soaked hamstring graft during ACLR). This study was conducted retrospectively from July 2019 to July 2022 at King Fahad Armed Forced Hospital. Institutional review board approvals were obtained from the same hospital, and all patients provided informed consent for participation in the surveillance study. IRB application number (REC 609), Date: 22/August/ 2023.

Results: The present study included 295 patients, of whom (20%, n = 60) received grafts of vancomycin and (80%, n = 235) received only traditional prophylactic antibiotics. In the vancomycin-soaked group, there was no infection (0%, n = 0). While all patients who developed post-infectious disease were members of the traditional prophylactic antibiotic group (1.3%, n = 3). The value of the effect size for the Oxford scale as a whole is equal to 0.98, which indicates that there is a great effect of vancomycin-soaked hamstring autograft and anterior cruciate ligament (ACL) reconstruction on improving the patient's condition. that the use of vancomycin-soaked hamstring graft during ACLR can reduce the risk of postoperative infection compared with conventional prophylactic antibiotics because sig. = 0.000 < 0.05 for the test of Mann-Whitney.

Conclusion: The current study adds to the body of literature regarding the benefits of soaking hamstring grafts in vancomycin, despite the benefits of this technique, it is not commonly used locally, further studies with larger sample sizes are needed to give further insight.

 Keywords: Anterior Cruciate Ligament Reconstruction (ACLR); Vancomycin-Soaked Hamstring Autograft; C-Reactive Protein

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