Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Hospital of Larissa, Mezourlo, 41110, Larissa, Greece.
Anesthesiology Department, Faculty of Medicine, School of Health Sciences, University of Hospital of Larissa, Larissa, Greece.
Knee Surg Sports Traumatol Arthrosc. 2021 Mar;29(3):876-880. doi: 10.1007/s00167-020-06040-2. Epub 2020 May 3.
To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates.
Between 2003 and 2014 (first study period), 1,242 patients underwent ACL reconstruction using autografts, without soaking them in vancomycin solution, while between 2014 and 2019 (second study period) all ACL autografts in 593 patients were soaked in a 5-mg/ml vancomycin solution, in a territory University Hospital. The same standard treatment of perioperative IV antibiotics was applied in both groups.
Postoperative septic arthritis occurred in seven out of 1,242 patients (0.56%) during the first study period. Bone patellar tendon bone autograft was used in 311 (25%) patients, and hamstring tendon autograft was used in the rest 931 (75%) of the study population during this period. All infected cases were male and had a hamstrings graft implanted. There were no postoperative infections (0%) in 593 ACL reconstructions during the second study period. Bone patellar tendon bone autograft was used in 178 (30%) patients while hamstring tendon autograft was used in the rest 415 (70%) of the study population, during this period. Statistical analysis revealed a significantly reduced postoperative infection rate (p = 0.018) between the two reported periods, with the main impact referring to the use of hamstrings autograft (p = 0.031) for the first study period.
Septic arthritis following ACL reconstruction can be significantly reduced (or even eliminated) by soaking ACL autografts in a 5 mg/ml vancomycin solution. Of note, this strategy seems to be more effective in the setting of hamstring tendon autograft use, since the risk of postoperative knee infection is significantly higher when this type of graft is used.
评估在进行前交叉韧带（ACL）重建时，将自体移植物局部浸泡万古霉素对术后感染率的影响。
在 2003 年至 2014 年（第一研究期）期间，1242 例患者接受了使用自体移植物的 ACL 重建，未将其浸泡在万古霉素溶液中，而在 2014 年至 2019 年（第二研究期）期间，593 例患者的所有 ACL 自体移植物均浸泡在 5mg/ml 万古霉素溶液中，在一所地区大学医院。两组均应用相同的围手术期 IV 抗生素标准治疗。
在第一研究期内，1242 例患者中有 7 例（0.56%）发生术后化脓性关节炎。在此期间，311 例（25%）患者使用骨髌腱骨自体移植物，其余 931 例（75%）患者使用腘绳肌腱自体移植物。所有感染病例均为男性，且植入了腘绳肌腱移植物。在第二研究期内，593 例 ACL 重建中无术后感染（0%）。在此期间，178 例（30%）患者使用骨髌腱骨自体移植物，其余 415 例（70%）患者使用腘绳肌腱自体移植物。统计分析显示，两个报告期之间的术后感染率显著降低（p=0.018），主要影响因素是第一研究期使用腘绳肌腱自体移植物（p=0.031）。
将 ACL 自体移植物浸泡在 5mg/ml 万古霉素溶液中可显著降低（甚至消除）ACL 重建术后的化脓性关节炎。值得注意的是，在使用腘绳肌腱自体移植物的情况下，这种策略似乎更为有效，因为当使用这种类型的移植物时，膝关节感染的风险显著增加。
