The Effect of Gentamycin in the Irrigating Solution to Prevent Joint Infection after Anterior Cruciate Ligament (ACL) Reconstruction

Background: Arthroscopic reconstruction of ACL is an effective method to restore knee stability after ACL rupture.Postoperative septic arthritis (SA) is very uncommon while the incidence of serious complications range between0.14% and 1.8%. Some of the devastating consequences of septic arthritis can encompass hyaline cartilage damage,arthrofibrosis, and in rare cases amputation. The purpose of this study was to evaluate the effect of gentamicin irrigationsolutions as a process to restrain septic arthritis following arthroscopic ACL reconstruction.Methods: In this retrospective cohort study, 1464 patients who underwent ACL reconstruction with hamstring tendonautograft in our institution over 7 years (February 2008 to January 2015) were included. The patients were dividedinto two groups based on the type of intra-articular irrigation solution used during the surgery. Patients in Group 1(Saline) received intra-articular irrigation with normal saline (0.9 % sodium chloride) solution, while those in Group 2(Gentamycin) received intra-articular irrigation with gentamicin (80 mg/L) added to the normal saline solution. Dataabout postoperative infection, its course, management, and outcome were obtained from patients’ records.Results: Seven patients developed SA, four of whom were from SALINE group (2.2%) and three from Gentamycingroup (0.23%). The incidence rate of SA after arthroscopic ACL reconstruction was significantly lower (P <0.05) whenirrigated with gentamicin solution than merely with saline solution.Conclusion: Gentamicin irrigation solution has a preservative and protective effect against SA development followingarthroscopic ACL reconstruction. We recommend evaluating this technique as a way in order to depreciate theprevalence of SA after ACL reconstruction.Level of evidence: III

Keywords:

ACL reconstruction , Gentamicin , Irrigating solution , Septic arthritis