The use of vancomycin-soaked wrapping of hamstring grafts to reduce the risk of infection after anterior cruciate ligament reconstruction: An early experience in a district general hospital.

introductionThe purpose of the study was to investigate whether pre-soaked hamstring graft with a solution of vancomycin followed by the 'vancomycin wrap' provides an effective way to reduce the risk of post-operative infection. We hypothesized that with the addition of the 'vancomycin wrap' there would be a significant reduction in the risk of post-operative infection.

methodsA retrospective review of data collected on 305 consecutive patients who underwent anterior cruciate ligament reconstruction (ACLR) with hamstring autograft from April 2012 to March 2019. In the initial 4-year period, 185 patients (group 1) underwent ACLR with pre-operative intravenous antibiotic. In the subsequent 3-year period, 120 patients underwent ACLR with vancomycin pre-soaked graft together with pre-operative intravenous antibiotic before tourniquet inflation. After graft harvest, the grafts were soaked into a 5 mg/ml vancomycin solution for 1 min. The graft was then fastened within the graft sizing tube and wrapped by a sterile gauze saturated with the vancomycin solution beforehand.

resultsA total of 3 culture-positive joint infection were documented (1.6%) in group I, requiring arthroscopic debridement. In group 2 no infection (0%) was recorded.

conclusionsWe proposed a safe, simple and easy-to-do method to reduce the risk of such complication.Prophylactic vancomycin soaking of hamstring autograft is effective to reduce the infection rate in this series compared with pre-operative antibiotic alone.