Rougereau Grégoire, Hassan Sammy Kassab, Valentin Eugénie, Jehan Sacha, Bauer Thomas, Baudrier Nicolas, Hardy Alexandre
Hospital Ambroise Pare, APHP, Boulogne Billancourt, France.
Hospital Pitie Salpetriere, APHP, Paris, France.
Orthop J Sports Med. 2024 Mar 4;12(3):23259671241228276. doi: 10.1177/23259671241228276. eCollection 2024 Mar.
Vancomycin soaking of the graft during arthroscopic anterior cruciate ligament reconstruction has been shown to be effective in reducing the rate of postoperative infection.
PURPOSE/HYPOTHESIS: The present study aimed to (1) analyze the effect of vancomycin-soaked grafts during arthroscopic anatomic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) on the incidence of infection and (2) evaluate the influence of infection on functional outcomes and identify the risk factors of infection. It was hypothesized that vancomycin soaking of the graft would reduce the postoperative infection rate.
Cohort study; Level of evidence, 3.
Consecutive patients at 2 centers who underwent ATFL/CFL reconstruction between December 2011 and July 2022 were included. All patients had undergone anterolateral arthroscopic debridement of the ankle and anatomic ATFL/CFL reconstruction with a gracilis tendon autograft. Vancomycin soaking of the graft was begun in both centers in January 2021. Complications, functional scores, return to sports (RTS) rates, and the level of return were compared between patients with and without vancomycin-soaked grafts and between patients with and without infection.
Overall, 182 patients (48% men; mean age, 34 ± 11.9 years) were included, with a mean follow-up of 23 ± 16.1 months. The rate of postoperative infection was significantly lower in the group with vancomycin soaking versus without (0/92 [0%] vs 8/90 [8.9%]; = .001). At the final follow-up, there were 26 complications (14.3%): 8 infections, 6 recurrent tears, and 12 peripheral neuropathies. The infections developed after a mean of 17 ± 11 days. The functional scores were excellent at the final follow-up (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Score, 86.5 ± 18.7; Karlsson score, 85 ± 18.3). Patients with infection had significantly decreased AOFAS scores (52.8 ± 27.6 vs 83.3 ± 21.5; = .003), Karlsson scores (57 ± 27.7 vs 83.6 ± 20; = .006), and RTS rates (25% vs 77%; = .005) versus patients without infection.
Vancomycin-soaked grafts for arthroscopic anatomic ATFL/CFL reconstruction decreased the rate of postoperative infection. Infection led to a deterioration in results. Vancomycin-soaking of the graft did not have a negative effect on functional results.
关节镜下前交叉韧带重建术中移植物用万古霉素浸泡已被证明可有效降低术后感染率。
目的/假设：本研究旨在（1）分析关节镜下解剖重建距腓前韧带（ATFL）和跟腓韧带（CFL）时，万古霉素浸泡移植物对感染发生率的影响，以及（2）评估感染对功能结局的影响并确定感染的危险因素。假设移植物用万古霉素浸泡可降低术后感染率。
队列研究；证据等级，3级。
纳入2011年12月至2022年7月期间在2个中心连续接受ATFL/CFL重建的患者。所有患者均接受了踝关节前外侧关节镜清创术以及使用股薄肌腱自体移植物进行的解剖学ATFL/CFL重建。2021年1月两个中心均开始对移植物进行万古霉素浸泡。比较使用和未使用万古霉素浸泡移植物的患者之间以及有和无感染的患者之间的并发症、功能评分、恢复运动（RTS）率和恢复水平。
总体而言，纳入了182例患者（48%为男性；平均年龄34±11.9岁），平均随访23±16.1个月。使用万古霉素浸泡的组术后感染率显著低于未浸泡组（0/92[0%]对8/90[8.9%]；P = 0.001）。在末次随访时，有26例并发症（14.3%）：8例感染、6例复发性撕裂和12例周围神经病变。感染平均在17±11天后发生。末次随访时功能评分良好（美国矫形足踝协会[AOFAS]踝-后足评分，86.5±18.7；卡尔森评分，85±18.3）。与未感染患者相比，感染患者的AOFAS评分（52.8±27.6对83.3±21.5；P = 0.003）、卡尔森评分（57±27.7对83.6±20；P = 0.006）和RTS率（25%对77%；P = 0.005）均显著降低。
关节镜下解剖学ATFL/CFL重建中使用万古霉素浸泡的移植物可降低术后感染率。感染导致结果恶化。移植物用万古霉素浸泡对功能结果没有负面影响。
