Vancomycin-Soaked Hamstring Autograft in Anterior Cruciate Ligament Reconstruction: A Strategy for Infection Prevention

Abstract

Septic arthritis following anterior cruciate ligament reconstruction (ACLR) is a rare but potentially devastating complication, with reported incidence rates ranging from 0.14% to 1.8%. Hamstring autografts carry a disproportionately higher infection risk compared to bone-patellar tendon-bone grafts, largely attributed to skin flora contamination during harvest and preparation. Vancomycin presoaking of hamstring autografts has emerged as a promising adjunct to standard intravenous prophylactic antibiotics in reducing postoperative joint infection. This review examines the anatomical basis of ACLR, infection epidemiology and microbiology, risk factors, and the current evidence supporting vancomycin graft soaking as a safe and effective prophylactic measure.