The role of vancomycin-soaking of the graft in anterior cruciate ligament reconstruction

Approximately 1% of anterior cruciate ligament reconstruction (ACLR) procedures develop septic arthritis despite intravenous antibiotic prophylaxis and other preventive measures. Infection is most commonly due to contamination during autograft harvest and preparation by introducing bacteria into the knee during graft insertion. Pre-soaking ACL grafts in 5 mg/mL vancomycin ("vancomycin wrap") has been utilised to eradicate such bacterial contamination. Many level III studies have reported a marked decrease in infection rates with no increase in graft failure rates. However, the lack of prospective randomised control trials and these studies' heterogeneity do not allow a universal recommendation for vancomycin pre-soaking of all grafts during ACLR. Randomised controlled trials are needed to confirm efficacy in reducing sepsis rates.