The Value of in-vitro Local Ceftriaxone Interrupted Irrigation for Soft Tissue Autograft in Arthroscopic ACL Reconstruction

Abstract

Background: Postoperative septic arthritis of the knee joint is an uncommon complication with serious consequences following anterior cruciate ligament reconstruction (ACLR). Systemic antibiotics received preoperatively and presoaking the soft tissue autograft with antibiotics result in a lower infection rate. Preoperative intravenous antibiotics may not be sufficient enough to reach minimum inhibitory concentration (MIC) levels due to poor vascularity of hamstring tendons in addition the harvested graft is prone to infection from skin flora. Aim of the study: To assess the efficacy of local antibiotic (ceftriaxone drug 1g.) solution diluted in (500 mL 0.9% sodium chloride N/S) for invitro interrupted irrigation of harvested soft tissue ACL graft as prophylaxis in reducing the infection rate during knee joint arthroscopic procedure. Patients and Methods: A Prospective comparative study of forty patients fit for arthroscopic anterior cruciate ligament reconstruction were enrolled in the study. The timeline period from April 2022 to July 2023.patients divided into (group A), twenty patients (received local ceftriaxone irrigation 1gm. solution diluted in 500 mL 0.9% NaCl for presoaking soft tissue autograft) and (Group B), twenty patients received (plain NaCl 0.9% ) only for irrigation of harvested graft. All patients in both groups received intravenous ceftriaxone at time of induction of anesthesia. Patients with history of injury more than 2years, open procedure, intravenous drug abuse, alcoholism steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Patients were followed postoperatively by clinical, laboratory, and imaging studies. The chi-square test was used for the comparison of categorical data. A student T-test and ANOVA were conducted to demonstrate the differences in postoperative inflammatory markers. Results: Presoaking of soft tissue autograft with ceftriaxone was performed in 20 patients (the study group), while 20 patients (the control group) were soaked only with plain N/S. In the control group, two patients (10%) developed postoperative infection after 2 weeks postoperatively, while no case developed infection in the study group. There was no statistically significant difference (p >0.05) between the study and control groups in terms of demographic characteristics, type of graft (p = 0.34), associated arthroscopic procedure (p = 0.35), and Lysholm score (p = 0.58). In the study group, there was a significant decrease in ESR (P = 0.01) after 4 weeks, Total lymphocyte count (p = 0.04), and Polymorphonuclear (p = 0.03) after 6 weeks postoperatively. Conclusion: Presoaking of hamstring autograft with ceftriaxone intraoperative may be alternative for other antibiotics in reducing rate of infection following arthroscopic anterior cruciate ligament reconstruction.