Vancomycin in Primary Anterior Cruciate Ligament Reconstruction. Is it Cost-Effective?
DOI:
https://doi.org/10.63403/re.v33i1.463Keywords:
Septic arthritis, Vancomycin in ACLR, Cost/benefit, ComplicationsAbstract
Introduction: septic arthritis (SA) associated with anterior cruciate ligament reconstruction surgery (ACLR) is a rare but potentially devastating complication. The incidence ranges between 0.14 and 1.8%. There is abundant literature that maintains that the use of vancomycin to soak STRI grafts can reduce the risk of infection, but there is little literature that demonstrates the economic cost-benefit of the systematic implementation of this protocol.
Objectives: to evaluate whether it is cost-effective to use vancomycin as an adjuvant to prevent AS in primary RLCA. Secondary functional results and complications of the procedure were reported.
Materials and methods: a prospective, blinded and randomized study was carried out, from February 2020 to February 2023. Two hundred and fifty patients were recruited, with ACLR with quadruple hamstrings. An intervention group with vancomycin-embedded grafts and the control group without antibiotics. Minimum follow-up of 2 years.
Results: in group A (with vancomycin) of 122 patients, no infections were reported. In group B (without vancomycin) of 123 patients, 3 infections were reported (p = 0.247). In group A, 427 dollars ($3.5 per vial of vancomycin) was spent; while in group B, due to the 3 cases of infection, 4,254 dollars were spent. No differences in relation to surgical time and postoperative pain. Patients in group A recorded greater satisfaction. No significant differences between both groups in relation to functional scores and non-infectious complications such as arthrofibrosis and re-rip.
Conclusions: the study shows that in the context of primary RLCA with STRI grafts, the use of topical vancomycin reduces the incidence of AS and consequently the excessive expenses associated with its treatment; Therefore, it is a valuable, cost-effective strategy. It does not significantly alter functional outcomes, graft healing, or associated non-infectious complications.
Level of evidence: II. Prospective Cohort Study
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