Comparative efficacy of vancomycin and gentamicin soaked hamstring autografts in reducing infection rates following ACL reconstruction

Sachin C. Thagadur; Prathap U. S.; Vijay Girish

doi:10.18203/issn.2455-4510.IntJResOrthop20263929

Authors

Sachin C. Thagadur Department of Orthopedics, M. S. Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
Prathap U. S. Department of Orthopedics, Shridevi Institute of Medical Sciences, Tumakuru, Karnataka, India
Vijay Girish Arthroscopy and Arthroplasty Surgeon, HOSMAT Hospital, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20263929

Keywords:

Anterior cruciate ligament reconstruction, Gentamicin, Graft presoaking, Hamstring autograft, Septic arthritis, Vancomycin

Abstract

Background: Deep knee infection after anterior cruciate ligament reconstruction (ACLR) is uncommon but carries a disproportionate clinical burden, often ending in graft loss and staged revision surgery. Because systemic antibiotics penetrate avascular tendon poorly, presoaking the harvested graft in a topical antibiotic solution has emerged as a practical adjunct to standard intravenous prophylaxis. Vancomycin has the largest published experience for this purpose, while gentamicin has been proposed as a comparably effective and more practical alternative. Objective was to directly compare vancomycin-soaked and gentamicin-soaked hamstring autografts for their effect on postoperative infection rate and functional recovery following arthroscopic ACLR.

Methods: Eighty patients undergoing primary ACLR over a six-month period were divided into two groups of 40: group 1 received autografts presoaked in vancomycin (500 mg/vial), and group 2 received autografts presoaked in gentamicin (40 mg/2 ml). Both groups received identical intravenous antibiotic prophylaxis, surgical technique, and rehabilitation. Functional recovery was assessed with the IKDC subjective knee score preoperatively and at three and six months.

Results: The cohort comprised 52 men and 28 women, with injuries distributed almost evenly between the right (36) and left (44) knee. Non-contact mechanisms accounted for the largest share of injuries (45), followed by road traffic accidents (20) and sport (15). One deep knee infection occurred in the entire cohort, in a patient from the gentamicin group (group 2), giving group-wise infection rates of 0% (group 1) and 2.5% (group 2). The combined IKDC score rose from a mean of 34±3.1 preoperatively to 54±2.6 at three months and 93.5±1.5 at six months.

Conclusions: Both vancomycin and gentamicin graft-presoaking were associated with a low overall infection rate and comparable functional recovery, supporting either agent as a reasonable, low-cost adjunct to intravenous prophylaxis during ACLR. Larger comparative trials are needed to establish whether either antibiotic carries a true advantage over the other.

Author Biographies

Prathap U. S., Department of Orthopedics, Shridevi Institute of Medical Sciences, Tumakuru, Karnataka, India

^{assistant professor}

Department of Orthopaedics, Shridevi Institute of Medical Sciences, Tumakuru, Karnataka, India

Vijay Girish, Arthroscopy and Arthroplasty Surgeon, HOSMAT Hospital, Bangalore, Karnataka, India

Consultant Arthroscopy and Arthroplasty surgeon Hosmat Hospital banglore

+91 98453 85217

dr.vijaygirish@gmail.com

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