Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function

Yoann Bohu, Shahnaz Klouche, Hasan Basri Sezer, Serge Herman, Olivier Grimaud, Antoine Gerometta, Alain Meyer, Nicolas Lefevre, Yoann Bohu, Shahnaz Klouche, Hasan Basri Sezer, Serge Herman, Olivier Grimaud, Antoine Gerometta, Alain Meyer, Nicolas Lefevre

Abstract

Purpose: To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking.

Methods: A case-control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1 « without vancomycin » before November 2016 and Group 2 « with vancomycin» after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated.

Results: 1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30 ± 9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p = 0.04). Knee function was comparable between the groups.

Conclusion: Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function.

Level of evidence: III.

Trial registration: https://ichgcp.net/clinical-trials-registry/NCT02511158" title="See in ClinicalTrials.gov">NCT02511158.

Keywords: ACL reconstruction; Comparative study; Functional results; Return to sport; Vancomycin.

Conflict of interest statement

S Klouche was paid by the Fonds de Dotation pour la Recherche Clinique en Orthopédie et Pathologie du Sport, Paris, FRANCE as consultant in clinical research. The other authors declare that they have no conflict to interest.

Figures

Fig. 1
Fig. 1
Study flow chart at inclusion

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