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    Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review
    (2021)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    Alex Vaisman
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    David Figueroa  
    ;
    João Espregueira-Mendes
    <jats:p> Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. </jats:p><jats:p> Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059 </jats:p>
      1Scopus© Citations 7
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    Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction
    (2020)
    FIGUEROA BERRIOS, FRANCISCO JAVIER  
    ;
    David Figueroa
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Alex Vaisman
    ;
    João Espregueira-Mendes
    <jats:p> There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic. Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft. When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee. </jats:p><jats:p> Cite this article: EFORT Open Rev 2020;5:221-225. DOI: 10.1302/2058-5241.5.190049 </jats:p>
      2Scopus© Citations 10
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    Scopus© Citations 17  1
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      22Scopus© Citations 41
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    Scopus© Citations 6  1
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    Hamstring autograft size importance in anterior cruciate ligament repair surgery
    (2018)
    Francisco Figueroa  
    ;
    David Figueroa
    ;
    João Espregueira-Mendes
    <jats:p> Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures. The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts &gt; 10 mm. Several methods – e.g. folding the graft in more strands – that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction. There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction. </jats:p><jats:p> Cite this article: EFORT Open Rev 2018;3:93-97. DOI: 10.1302/2058-5241.3.170038 </jats:p>
      17Scopus© Citations 55
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    Presoaking of Hamstring Autografts in Vancomycin Decreases the Occurrence of Infection Following Primary Anterior Cruciate Ligament Reconstruction
    (2019)
    David Figueroa
    ;
    Francisco Figueroa  
    ;
    CALVO RODRIGUEZ, RAFAEL  
    ;
    Mario Lopez
    ;
    Ignacio Goñi
    <jats:sec><jats:title>Background:</jats:title><jats:p> Postoperative septic arthritis is an uncommon but potentially devastating complication after anterior cruciate ligament (ACL) reconstruction. Our group started presoaking grafts with vancomycin to decrease this risk. </jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p> To compare the rate of septic arthritis in primary hamstring autograft ACL reconstruction with and without vancomycin-presoaked grafts. </jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p> Cohort study; Level of evidence, 3. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Consecutive periods were studied, inclusive of April 2013 through October 2015 (pre-vancomycin protocol) and November 2015 through May 2018 (vancomycin protocol). A total of 490 patients were included in the study: 230 in the pre-vancomycin protocol and 260 in the vancomycin protocol. All patients who underwent a primary hamstring autograft ACL reconstruction by 2 senior surgeons during the periods studied were included. The final outcome studied was occurrence of highly probable postoperative septic arthritis in both groups. Diagnosis of probable septic arthritis was made by clinical diagnosis as well as cytological analysis of joint aspiration (cell count &gt;50,000/μL and &gt;90% neutrophils). Statistical analysis was performed with the Fisher exact test. Significance was set at P &lt; .05. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Four cases of probable postoperative septic arthritis were noted in the pre-vancomycin protocol (1.7%; 2 cases per surgeon), while no cases of septic arthritis were noted in the vancomycin protocol during the study period ( P &lt; .05). Diagnosis was made at a mean 21.7 days (range, 16-25 days). Staphylococcus epidermidis was isolated in 2 cases, and in the other 2 cases, no organism was isolated. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Presoaking of hamstring autografts in vancomycin for primary ACL reconstruction prevented the occurrence of postoperative septic arthritis during the study period as compared with no soaking of the grafts. </jats:p></jats:sec>
      13Scopus© Citations 31