Management of Intra-operative Contamination of an Anterior Cruciate Ligament Reconstruction Graft: A Cross-Sectional Survey of UK Orthopaedic Surgeons.

Abstract

Purpose Intra-operative anterior cruciate ligament (ACL) graft contamination is a rare but recognised complication. There are no guidelines or consensus on the management of this occurrence. Our aim was to survey trauma and orthopaedic surgeons with a knee subspecialty interest in the United Kingdom (UK) who perform ACL reconstruction (ACLR) to explore the preferred strategy when there is intra-operative graft contamination. Methods An online questionnaire was sent to UK ACLR surgeons. The survey included the year of training completion, the average number of ACLs per year, whether they have experienced any intra-operative graft contamination, the strategies implemented, and whether they are aware of any literature and how it has influenced their strategies. Results Twenty-eight responses were received, with an average of 11 years of experience in ACLR, totalling an estimated of more than 15,000 ACLR. Three surgeons surveyed had experienced a single intra-operative ACL graft contamination, all of which were soaked in chlorhexidine gluconate (CG) solution. Of those surgeons who had not encountered a contaminated graft, 11 (44%) would use CG, 7 (28%) would soak in saline and vancomycin solution, and 7 (28%) would harvest a new graft. Conclusions There is significant variation in management strategy for an intra-operative contaminated graft in ACLR. This variation highlights the need for further work to develop a consensus for guidance for ACLR surgeons.