Abstract
Objectives:
Infection can be a devastating complication of anterior cruciate ligament (ACL) reconstruction. Soaking or wrapping grafts in vancomycin solution has been adopted by many surgeons to prevent infection following ACL reconstruction. Recent meta-analysis demonstrated a significant reduction in the incidence of deep infection in vancomycin-soaked grafts to be 0.09% compared to 0.74% for nontreated grafts.1 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 with tobramycin-soaked grafts as well as characterize potential risk factors for infection. 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:
A total of 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 identify postsurgical superficial and deep wound infections, as well as other pertinent surgical characteristics. The incidence of infection in this tobramycin wrap cohort was compared to the incidence of infection of vancomycin wraps as published in the literature.
Results:
Superficial wound infections occurred in 24 patients (2.96%) and 0 deep joint infections were identified in the tobramycin wrap cohort. The incidence of infection was 3.16% in 728 patients who received prophylactic perioperative intravenous Cefazolin and 1.23% infection incidence in 81 patients who received prophylactic perioperative Clindamycin (p = 0.30). In addition, no significant difference in incidence of superficial infection was found with patient age, sex, body mass index, or graft type.
Conclusions:
Tobramycin-soaked ACL grafts demonstrate a low infection risk comparable to that of vancomycin-soaked ACL grafts. The type of prophylactic IV antibiotic used in this young cohort did not impact the incidence of superficial wound infection. Further work with larger and older cohorts is needed to better characterize risk factors for postoperative infection following ACL reconstruction for all ages and comorbidities.