Title : Management of intra-operative contamination of an ACL graft: A cross-sectional survey of UK orthopaedic surgeons
Abstract:
Purpose: Intra-operative Anterior Cruciate Ligament (ACL) graft contamination is a rare but recognised complication. There are no guidelines or consensus on the management of this occurrence. Our aim was to survey trauma and orthopaedic surgeons with a knee subspecialty interest in the United Kingdom (UK) who perform Anterior Cruciate Ligament Reconstruction (ACLR) to explore the preferred strategy when there is intra-operative graft contamination.
Methods: An online questionnaire was sent to UK ACLR surgeons. The survey included the year of training completion, the average number of ACLs per year, whether they have experienced any intra-operative graft contamination, the strategies implemented, and whether they are aware of any literature and how it has influenced their strategies.
Results: 28 responses were received with an average of 11 years of experience in ACLR totalling in an estimate of more than 15000 ACLR. Three surgeons surveyed had experienced a single intra-operative ACL graft contamination all of which were soaked in Chlorhexidine Gluconate solution (CG). Of those surgeons who had not encountered a contaminated graft 11 (44%) would use CG, 7 (28%) would soak in saline and vancomycin solution and 7 (28%) would harvest a new graft.
Conclusions: There is significant variation in management strategy for an intraoperative contaminated graft in ACLR. This variation highlights the need for further work to develop a consensus for guidance for ACLR surgeons.
