Vancomycin soaking of ACL reconstructions does not alter the mechanical strength.

Abstract

Reconstruction of the anterior cruciate ligament (ACL) using hamstring autograft presents a greater risk of surgical site infection than other transplants (0.5% to 1.5%). Various prophylactic methods have been evaluated, such as double antibiotic protection with intravenous Cefazolin and soaking of the transplant with vancomycin, which results in a near- zero infection rate. This soaking method has only been studied in vitro, confirming the absence of toxicity of vancomycin on tenocytes. The primary objective of our study was to assess the mechanical quality of vancomycin-soaked tendon transplants at 6 months post-operatively. The secondary objective was to assess the rate of new rupture at 1 year. This is a retrospective, single-center study including patients who underwent ACL reconstruction using a vancomycin- soaked hamstring autograft at Rennes University Hospital between December 2018 and February 2021. An objective assessment of joint laxity by means of the GNRB® at 134N was performed at 6 months post-operatively and a clinical evaluation (Lysholm and subjective IKDC questionnaires) at 1 year were performed. Fifty-three patients aged between 18 and 57 years were included. At 6 months, GNRB® of the operated knee joints was significantly different compared with the non-operated ones but was below the threshold for complete or partial rupture according to the manufacturer's clinical significance threshold (3 mm for a complete rupture and 1.5 mm for a partial rupture). At one year, 3.8% of our population had an early rupture, the reason for which was technical defects in the positioning of the graft. The stability of knees reconstructed with a Vancomycine soaked ACL graft is comparable with that of the contralateral knee with an intact ACL. Level of evidence : IV, retrospective study.