Figueroa Francisco, Figueroa David, Calvo Rafael, Vaisman Alex, Espregueira-Mendes João
Clinica Alemana-Universidad del Desarrollo, Santiago, Chile.
Hospital Sotero del Rio, Santiago, Chile.
EFORT Open Rev. 2021 Mar 1;6(3):211-216. doi: 10.1302/2058-5241.6.200059. eCollection 2021 Mar.
Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis.Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented.Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries.Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. Cite this article: 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059.
与其他移植物相比，在前交叉韧带（ACL）重建中使用腘绳肌自体移植物与感染风险增加有关。其确切原因尚不清楚，移植物采集和制备后的污染是最被认可的假设。基于受污染的移植物可能是术后感染性关节炎的主要因素这一理论，并为了使移植物的抗生素疗效最大化，开发了万古霉素预浸泡技术。该技术已成功降低了ACL重建中的感染率。近年来，出现了大量使用该方案的研究文章，但该技术仍未得到广泛应用。近期文献表明，在腘绳肌自体移植物ACL重建后，对移植物进行万古霉素预浸泡已成功降低了感染率。它在降低其他类型移植物（髌腱、股四头肌肌腱、同种异体移植物）以及同时进行韧带手术或开放手术的患者的感染率方面也显示出疗效。尽管万古霉素预浸泡对降低ACL重建后的感染率有积极作用，但缺乏前瞻性随机对照试验以及不同研究的异质性意味着，普遍建议对每位ACL重建患者的移植物进行万古霉素预浸泡是不可行的。引用本文：2021；6：211 - 216。DOI：10.1302/2058 - 5241.6.200059。
