Summary
Soaking ACL grafts in tobramycin resulted in no deep infections in 812 consecutive young patients undergoing ACL reconstruction.
Abstract
Introduction
While rare, infection can be a devastating complication of anterior cruciate ligament (ACL) reconstruction. Soaking grafts in vancomycin solution has been adopted by many surgeons to prevent infection following ACL reconstruction and a recent meta-analysis demonstrated the incidence of deep infection in vancomycin-soaked grafts to be 0.09% compared to 0.74% for non-treated grafts. Tobramycin may provide an alternative for patients with vancomycin allergies or if vancomycin is not available. The purpose of this study is to evaluate the incidence of deep and superficial infection following ACL reconstruction in young patients treated with tobramycin-soaked grafts. We hypothesize that tobramycin-soaked grafts result in a low deep infection rate, comparable to that of vancomycin-soaked grafts published in the literature.
Methods
812 consecutive patients under age 20 who underwent ACL reconstruction at an academic medical center between 2010 and 2020 with tobramycin-soaked grafts were identified. Retrospective chart review was performed to collect surgical data, identify which systemic perioperative antibiotics were given, and identify postsurgical superficial and deep wound infections.
Results
In this cohort, 0 deep joint infections were identified in 812 consecutive patients, while superficial wound infections occurred in 24 patients (2.96%). Superficial infections occurred in 23 of 728 patients who received perioperative intravenous Cefazolin (3.16%) and 1 of the 81 patients who received perioperative intra-venous Clindamycin (1.23%). No significant differences in patient demographics were noted between those who developed a superficial infection and those who did not.
Conclusions
Soaking ACL grafts in tobramycin resulted in no deep infections in young patients undergoing ACL reconstruction. The incidence of superficial infections was low.