[Peroperative accidental contamination of bone-tendon-bone graft for the reconstruction of the anterior cruciate ligament. Report of 4 cases].
OBJECTIVE
The aim of this paper is to report the outcome in four patients in whom the graft (bone-patellar tendon-bone) was dropped onto the operating-room floor during anterior cruciate ligament reconstruction, and was then re-implanted after decontamination by topic antibiotic treatment.


METHODS
Between 1992 and 1996, 1038 anterior cruciate ligament reconstructions were performed. In four cases, the bone-patellar-tendon-bone graft was dropped onto the operating theater floor. The graft was then soaked in rifamycin at a concentration of 0.8 mg/ml in normal saline for 10 mn, and soaked in gentamycin at 0.6 mg/ml for a further 10 mn. Finally, the graft was washed in physiological saline. All cases had been given a loading dose of second generation cephalosporin (cefamandole), after deflating the tourniquet. Post-operatively, the patients were given amoxicillin and clavulanic acid for 15 days. The patients were reviewed radiologically and clinically (IKDC form) with a mean follow-up of 24 months.


RESULTS
Post operatively all patients had an uncomplicated recovery. No wound problems was observed in 3 of the four patients achieved an IKDC grade A knee. The final patient had a grade B, after 55 month follow-up. All patients recovered their initial sport level. The radiological Lachman test shows a mean differential value of 0.3 mm.


CONCLUSIONS
Dropping the graft during ACL reconstruction is a very rare problem. In this event, the surgeon can choose several options: Harvesting an other site, sterilizing the graft by irradiation, autoclaving, ethylene oxyde..., or using a topical antibiotic treatment. Cooper showed, in an in vitro study that the contamination rate was halved by antibiotic soaking of the graft.


CONCLUSIONS
We used a topic antibiotic treatment with success in all four cases. We feel warranted the implantation of a graft which has been dropped, and then antibiotic soaked. The patient should of course be informed and told to report any sign or symptom of infection. On the strength of this result, we would like to propose a decontamination protocol which can be used in this sort of incident, fortunately very rare.
Casalonga
D
D
Centre Livet-Hôpital de la Croix-Rousse, Caluire.
Ait Si Selmi
T
T
Robinson
A
A
Neyret
P
P
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001424:Bacterial Infections / Q000517:prevention & control*; D006801:Humans; D007432:Intraoperative Period; D010329:Patella / Q000637:transplantation*; D011183:Postoperative Complications / Q000517:prevention & control*; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000637:transplantation*