Abstract
Purpose
To evaluate the effect of soaking of anterior cruciate ligament (ACL) grafts in vancomycin
solution on graft biomechanical properties at the time of implantation.
Methods
The central third of patellar tendons was harvested from mature bovine knees and prepared
as a tendon-only graft or a bone-tendon-bone (BTB) graft. Tendons were wrapped in
gauze soaked in vancomycin solution (VS) (5 mg/mL) or normal saline (NS) and left
to stand for 30 minutes at room temperature, simulating graft exposure times in the
operating room during ACL reconstruction. Tensile testing was carried out on a materials
testing system with (1) low-magnitude loading (60 N at 3 mm/s) with repeated testing
of tendon-only grafts; and (2) high-magnitude loading (600 N at 10 mm/min) of BTB
grafts. For tendon-only grafts, specimens were first wrapped in NS-soaked gauze and
underwent testing, with repeated testing performed after wrapping in gauze soaked
in VS or buffered VS (pH 7.0). For BTB grafts, specimens were randomly assigned to
treatment with VS or NS.
Results
For tendon-only grafts, there was no difference in Young’s modulus (YM) after soaking
with VS soaking (baseline, 12.69 MPa; treatment, 16.07 ± 4.44 MPa; P = .99) or buffered VS (baseline, 12.45 ± 4.55 MPa; treatment, 15.56 ± 2.83 MPa; P = .99). For BTB grafts, there were no differences in elongation strain (VS, 46.8%
± 7.0%; NS, 31.5% ± 13.5%, P = .19) or YM (VS, 158.4 ± 15.8 MPa; NS, 158.5 ± 23.3 MPa, P = .99).
Conclusions
According to controlled biomechanical tests, vancomycin soaking of patellar tendon
grafts does not adversely affect time-zero material properties.
Clinical Relevance
This study suggests that vancomycin wrapping has no immediate adverse effects on the
biomechanical properties of ACL grafts. Randomized controlled trials are warranted
to validate the widespread use of vancomycin soaking of tendon grafts for infection
prophylaxis during ACL reconstruction.
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Article info
Publication history
Published online: October 29, 2020
Accepted:
October 19,
2020
Received:
March 17,
2020
Footnotes
See commentary on page 961
The authors report the following potential conflicts of interest or sources of funding: J.N.L. reports personal fees, Smith & Nephew. T.C. is the Director of Scientific Affairs, AGelity Biomechanics, and reports equity, AGelity Biomechanics. R.F.W. reports personal fees and other, Orthonet. S.A.R. reports personal fees, Advance Medical, Ortho RTI. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
