Role of Vancomycin-Soaked Hamstring Autograft in Reducing the Occurrence of Infection Following Primary Anterior Cruciate Ligament Reconstruction

Background: Postoperative septic arthritis is an uncommon but potentially devastating complication following anterior cruciate ligament reconstruction (ACLR). Hamstring autograft use, concomitant open procedures, drain usage, and prior ipsilateral knee surgery have been identified as risk factors. Staphylococci account for up to 90% of causative organisms. Presoaking of the autograft in vancomycin has recently emerged as a promising prophylactic strategy. Aim: To investigate whether presoaking of hamstring autografts in vancomycin solution reduces the rate of postoperative septic arthritis following primary ACLR. Patients and Methods: A retrospective and prospective cohort study was conducted at Orthopedic Surgery Department, Faculty of Medicine, Zagazig University Hospital. Eighteen patients who underwent arthroscopic primary ACLR with hamstring autograft were divided into two groups: Group I received standard intravenous prophylactic antibiotics without vancomycin graft soaking and Group II received intravenous prophylactic antibiotics combined with vancomycin presoaking of the hamstring graft. Results: No significant differences were observed in early complications between groups. However, there was a statistically significant difference in the rate of late septic arthritis, with 3 cases (33.3%) occurring in Group I and none (0.0%) in Group II. Knee Injury and Osteoarthritis Outcome Score (KOOS) scores improved significantly postoperatively in both groups, with no significant difference between groups in pre- or postoperative scores. Conclusion: Vancomycin presoaking of hamstring autografts in primary ACLR significantly reduced the occurrence of postoperative septic arthritis compared to intravenous prophylaxis alone, without adversely affecting functional outcomes. These findings support the incorporation of vancomycin graft soaking as a standard prophylactic measure. ？