These authors investigated the rate of infection after ACL reconstruction with and without graft preparation with a vancomycin irrigant. Treated grafts were soaked in 500 mL of 1-mg/mL solution of vancomycin for an average of 10 minutes and were then wrapped in vancomycin soaked
gauze sponge after graft preparation and prior to graft insertion.
Infection was defined as a return to the operating room for irrigation and debridement within 90 days after ACL reconstruction.
In total, 1,640 patients (952 males; 58.0%) with a mean age (and standard deviation) of 27.7 ± 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%), whereas 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin.
In total, 11 reconstructions (0.7%) were followed by infection, which occurred in 10 (1.2%) of the patients in whom the graft was not soaked in vancomycin and in 1 (0.1%) of the patients in whom the graft was soaked in vancomycin (p = 0.032).
Age (p = 0.571), sex (p = 0.707), smoking (p = 0.407), surgeon (p = 0.124), and insurance type (p = 0.616) were not associated with postoperative infection risk.
Autograft use was associated with decreased infections (p = 0.045).
There was an 89.4% relative risk reduction with the use of intraoperative vancomycin. An increased body mass index (BMI) (p = 0.029), increased operative time (p = 0.001), and the absence of ACL graft preparation with vancomycin (p = 0.032) independently predicted postoperative infection.
The authors concluded that the use of vancomycin-soaked grafts was associated with a 10-fold reduction in infection after ACL reconstruction (0.1% versus 1.2%; p = 0.032). Other risk factors for infection after ACL reconstruction included increased BMI and increased operative time.
Comment: This was not a study of shoulders and the infections were not due to Cutibacterium so we cannot be sure that the results are applicable to shoulder arthroplasty. Also the cases without Vanc were performed at earlier time points than those with Vanc, so other factors may contribute to the difference noted. Finally, it is not clear whether this use of Vanc (soaking the graft) is effective against contamination of the graft while it is on the surgical field or whether it is a means of applying topical Vanc to the wound.
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