title: No infections in 1300 anterior cruciate ligament reconstructions with vancomycin pre-soaking of hamstring grafts.
abstract: OBJECTIVE
  To investigate the pre-soaking of hamstring grafts in topical vancomycin, in addition to IV prophylaxis, during anterior cruciate ligament (ACL) reconstruction to reduce the incidence of post-operative infection, and to describe an evidence-based diagnostic and treatment algorithm to facilitate early diagnosis and appropriate management of possible knee sepsis post-operatively after ACL reconstruction.
  
  
  METHODS
  This study is a controlled observational series comprising of 1585 individuals who underwent ACL reconstruction over a 13-year period. All surgeries were performed by a single surgeon at the same hospital. Group 1 consisted of 285 patients who received pre-operative IV antibiotics without topical graft pre-soaking. Group 2 consisted of 1300 individuals who received IV antibiotics and graft pre-soaking in a vancomycin solution of 5 mg/mL.
  
  
  RESULTS
  In group 1, a total of four patients suffered a post-operative joint infection (1.4 %). Three out of the four were culture positive for Staphylococcus species. The fourth was culture negative but was managed as an acute infection. Group 2 suffered no post-operative infections (0 %). Statistical analysis of the vancomycin pre-soak with IV antibiotics group, compared with IV antibiotics-alone group, revealed a significantly reduced post-operative infection rate using a Fisher's exact test (P = 0.0011) and Chi-square test with Yates' correction (P = 0.0003).
  
  
  CONCLUSIONS
  Pre-soaking of hamstrings grafts with topical vancomycin reduced the rate of post-operative infection when compared to IV antibiotics alone. This technique should be utilised by surgeons to reduce the overall incidence of knee sepsis post-ACL reconstruction.
  
  
  METHODS
  III.
authors.affiliation: Department of Orthopaedics, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, Gold Coast, QLD, 4215, Australia. michael.phegan@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Phegan
authors.affiliation: Department of Kinesiology and Health Sciences, Stephen F. Austin State University, Nacogdoches, TX, USA.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Grayson
authors.affiliation: Knee Research Australia, Centre for Musculoskeletal Research, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Vertullo
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001170:Arthritis, Infectious / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D019737:Transplants / Q000601:surgery*; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: Anterior cruciate ligament reconstruction; Diagnostic algorithm; Infection; Infection prophylaxis; Prevention; Vancomycin