Vol.:(0123456789) 1 3 Knee Surgery, Sports Traumatology, Arthroscopy https://doi.org/10.1007/s00167-020-06040-2 KNEE Soaking of autografts with vancomycin is highly efective on preventing postoperative septic arthritis in patients undergoing ACL reconstruction with hamstrings autografts Konstantinos Banios 1  · George A. Komnos 1  · Vasilios Raoulis 1  · Metaxia Bareka 2  · George Chalatsis 1  · Michael E. Hantes 1 Received: 29 February 2020 / Accepted: 27 April 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020 Abstract Purpose To evaluate the impact of local soaking of the autografts with vancomycin during anterior cruciate ligament (ACL) reconstruction on postoperative infection rates. Methods Between 2003 and 2014 (frst study period), 1,242 patients underwent ACL reconstruction using autografts, with- out 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. Results Postoperative septic arthritis occurred in seven out of 1,242 patients (0.56%) during the frst 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 signifcantly 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 frst study period. Conclusions Septic arthritis following ACL reconstruction can be signifcantly reduced (or even eliminated) by soaking ACL autografts in a 5 mg/ml vancomycin solution. Of note, this strategy seems to be more efective in the setting of hamstring tendon autograft use, since the risk of postoperative knee infection is signifcantly higher when this type of graft is used. keywords Anterior cruciate ligament reconstruction · Knee infection · Vancomycin · Graft soaking Introduction Septic knee arthritis is one of the most devastating com- plications following anterior cruciate ligament reconstruc- tion (ACLR) [24]. The incidence rate ranges from 0.14 to 1.8% [8, 13, 20, 25, 27]. Despite its low incidence, the con- sequences following this complication are not negligent, including failure of the graft, loss of hyaline cartilage and arthrofbrosis that may lead to compromised functional outcomes, patient dissatisfaction, and excessive costs, up to six times higher than the initial surgery [13]. Postopera- tive infection can seriously deteriorate the fnal long-term outcome in the patient’s afected knee. Presence of bacte- ria inside the articular knee space is accused of provoking degenerative changes and osteophyte formation, impairing the knee function, even though the infection is eradicated [13, 21]. Several predisposing risk factors, such as the use of a hamstring graft, additional open surgical procedures and previous operations to the knee have been correlated with a higher incidence of knee joint infection following ACLR [2, 9]. The most common pathogen isolated in infected cases is Staphylococci species, with Coagulase-Negative Staphylococcus (CNS) being the predominant one [4]. Other * Michael E. Hantes hantesmi@otenet.gr 1 Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Hospital of Larissa, Mezourlo, 41110 Larissa, Greece 2 Anesthesiology Department, Faculty of Medicine, School of Health Sciences, University of Hospital of Larissa, Larissa, Greece