Response/Recommendation:

Yes, autograft tissue should be soaked in an antibiotic solution prior to implantation during ACL reconstruction.

Strength of Recommendation: Strong

Rationale:

Infection after ACL reconstruction is uncommon but can cause serious complications.1 Contributing factors that may lead to infection include diseases such as diabetes, smoking, increased time of surgery and tourniquet inflation, additional or larger incisions for arthroscopic portals and the use of a drain.2

The use of preoperative prophylactic antibiotic has been previously established to reduce infection rates in orthopedic surgery procedures.3 Traditionally, allograft anterior cruciate ligament (ACL) grafts have been associated with a higher concern …show more content…
Vancomycin has been reported for its use for local antibiotic infusion into joints.8 Vertullo et al. investigated the utility of soaking hamstring autografts with vancomycin before implementation during ACL reconstruction. In their investigation, both patient cohorts received preoperative (intravenous) IV antibiotics while one group additionally received a presoaked vancomycin graft. A statistical difference in infection rates was noted between the two patient groups as the preoperative IV antibiotic only group reported an infection rate of 1.4% compared to a 0% rate for the vancomycin group.9

Further, Pérez‑Prieto et al. performed a similar study as both patient cohorts received preoperative IV antibiotics while one group also received a presoaked vancomycin graft. However, in this series BTB autografts were included as well.10 The group without vancomycin saturation of the graft had an infection rate of 1.85% while the group of patients who received systemic antibiotic prophylaxis and graft presoaking with vancomycin did not experience any infections