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  • A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction

    Author(s)
    Vertullo, Christopher J
    Quick, Mark
    Jones, Andrew
    Grayson, Jane E
    Griffith University Author(s)
    Vertullo, Christopher J.
    Grayson, Jane
    Year published
    2012
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    Abstract
    Purpose: The purpose of this study was to investigate whether presoaking hamstring graft with a dilute antibiotic solution provides a potential new tool to improve measures to prevent joint infection. Methods: This is a retrospective analysis of data that were prospectively collected for 1,135 consecutive patients who underwent anterior cruciate ligament reconstruction (ACLR) during a 7-year period. In the initial 3-year period, 285 patients (group 1) underwent ACLR with a hamstring autograft with preoperative intravenous (IV) antibiotics. In the subsequent 4-year period, 870 patients underwent ACLR with a vancomycin-presoaked ...
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    Purpose: The purpose of this study was to investigate whether presoaking hamstring graft with a dilute antibiotic solution provides a potential new tool to improve measures to prevent joint infection. Methods: This is a retrospective analysis of data that were prospectively collected for 1,135 consecutive patients who underwent anterior cruciate ligament reconstruction (ACLR) during a 7-year period. In the initial 3-year period, 285 patients (group 1) underwent ACLR with a hamstring autograft with preoperative intravenous (IV) antibiotics. In the subsequent 4-year period, 870 patients underwent ACLR with a vancomycin-presoaked hamstring autograft (group 2) with preoperative IV antibiotics. Presoaking involved wrapping hamstring tendon autografts in a sterile gauze swab, which had been previously saturated with 5-mg/mL vancomycin solution. Results: In group 1 a total of 4 postoperative joint infections were documented (1.4%). Each case showed increasing pain and effusion, as well as a high intra-articular white blood cell count and increased C-reactive protein level. Of the 4 infected cases, 3 cultured coagulase-negative Staphylococcus (Staphylococcus epidermidis). The fourth case was treated as a postoperative infection despite a negative culture and responded to arthroscopic washout and IV antibiotics. In group 2 no infections (0%) were recorded, and no investigatory washouts occurred. The difference was statistically significant. Known failures were similar in each group. Conclusions: Prophylactic vancomycin presoaking of hamstring autografts statistically reduced the infection rate in this series compared with IV antibiotics alone. Level of Evidence: Level IV, therapeutic case series.
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    Journal Title
    Arthroscopy: Journal of Arthroscopic & Related Surgery
    Volume
    28
    Issue
    3
    Publisher URI
    http://www.arthroscopyjournal.org/article/S0749-8063%2811%2901046-2/abstract
    Subject
    Clinical sciences
    Publication URI
    http://hdl.handle.net/10072/49323
    Collection
    • Journal articles

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