Intraoperative anterior cruciate ligament graft contamination
Charles B Pasque1, Timothy M Geib
1Division of Sports Medicine, Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. charlespasque@ouhsc.edu
Abstract:
Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family.
Insights
Intraoperative anterior cruciate ligament (ACL) graft contamination can be managed by immediate cleansing and reimplantation. This protocol, including antiseptic solutions and antibiotics, offers a viable option for surgeons facing this rare complication.
Area of Science:
- Orthopedic Surgery
- Surgical Contamination Management
Background:
- Intraoperative anterior cruciate ligament (ACL) graft contamination is a rare yet significant surgical complication.
- Such events are more common in surgeons new to practice or unfamiliar settings.
Observation:
- A protocol for managing intraoperative ACL graft contamination was developed based on literature review and three case experiences.
- The protocol involves immediate graft retrieval, suture removal, and cleansing with chlorhexidine and a triple antibiotic solution, followed by saline rinse.
Findings:
- Successful reimplantation of a cleansed ACL graft is a feasible option.
- The protocol includes replacing graft sutures, resizing the graft, and adjusting tunnels as necessary.
- Postoperative management involves intravenous or oral antibiotics for 1-2 weeks and close clinical follow-up for 6 weeks.
Implications:
- This approach provides a practical solution for surgeons encountering ACL graft contamination.
- Effective management can potentially prevent graft failure and improve patient outcomes.
- Clear communication with patients and families is crucial throughout the management process.
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