A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts.

PURPOSE

To survey leaders in sports medicine who perform anterior cruciate ligament (ACL) reconstructions to determine the preferred management when ACL graft contamination occurs.

TYPE OF STUDY

Survey study of expert opinions and experiences on the management of ACL graft contamination.

METHODS

We mailed 337 surveys to directors of academic sports medicine programs and graduates from an accredited sports medicine fellowship. The survey questioned the incidence, treatment, and outcome of ACL graft contamination.

RESULTS

Twelve surveys were returned to sender; 196 surgeons responded from the remaining 325 surveys (60%). Forty-nine of 196 (25%) surgeons reported at least 1 contamination during their career. Of those 49, 43 surgeons (88%) had 1 contaminated graft, 5 (10%) had 2, and 1 had 4, for a total of 57 reported contaminated grafts. Of the surgeons who reported a contaminated graft, 22 (45%) performed between 40 and 100 ACL reconstructions annually, and 17 (35%) performed more than 100 ACL reconstructions annually. Forty-three of the 57 (75%) contaminated grafts were managed with cleansing of the graft and proceeding with reconstruction. Ten (18%) were managed by harvesting a different graft, and 4 (7%) were substituted with an allograft. No infections in any of the contaminated grafts were reported. Sixty-five of the 147 (43%) surgeons without graft contamination gave hypothetical management responses. Thirty-eight (58%) would cleanse the graft and proceed with the procedure, 22 (34%) would harvest a different graft, and 5 (8%) would use an allograft.

CONCLUSIONS

Surgeons who perform a high volume of ACL reconstruction surgery most often choose graft cleansing as the preferred management for intraoperative ACL graft contamination.

LEVEL OF EVIDENCE

Level V, expert opinion.