Clinical efficacy of arthroscopic calcium sulfate loaded with vancomycin and implanted to treat postoperative infection after anterior cruciate ligament reconstruction

Abstract

Purpose To evaluate the efficacy of vancomycin-loaded calcium sulfate for treating postoperative infection after anterior cruciate ligament (ACL) reconstruction, provide a foundation for early diagnosis and treatment of postoperative infection of the anterior cruciate ligament. Methods Between September 2015 and September 2021, 34 patients with postoperative ACL infection received treatment. The infected patients were divided into calcium sulfate group and arthroscopic cleaning group. The blood routine chemistry, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were followed up at 1, 2, and 3 weeks postsurgically; knee mobility and visual analog scale (VAS) scores were evaluated at 6 weeks postsurgically; and the knee stability (KT-2000), Lysholm scores, the International Knee Documentation Committee (IKDC) scores, and Tegner scores were followed up at 2 years postsurgically. Results The knee range of motion and VAS score of both groups of patients improved significantly at 6 weeks postsurgically compared to presurgically (P < 0.05). Seven patients in the arthroscopic cleaning group still did not achieve the normal knee range of motion after 6 weeks, and four of them underwent manual release surgery under general anesthesia again. There was a significant improvement in knee joint stability, Lysholm scores, IKDC scores, and Tegner scores between the two groups of patients at the 2-year follow-up (P < 0.05). The Lysholm score and IKDC score of the calcium sulfate group were better than those of the arthroscopic cleaning group, and the differences between the groups were statistically significant (P < 0.05). Between the two groups, there was no significant difference in knee joint stability or Tegner score (P > 0.05). Conclusions Arthroscopic debridement combined with vancomycin-loaded calcium sulfate antibacterial particles in intra-articular filling can reduce the incidence of knee joint adhesion in ACL reconstruction patients with infections and has good therapeutic efficacy, making it worthy of clinical application. Level of evidence: Level III.