Vancomycin Presoaking of Grafts in anterior cruciate ligament reconstruction: Incidence of septic events and cost-effectiveness analysis based on the registry of the Francophone Arthroscopic Society.

BACKGROUND: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare but serious complication with significant clinical and economic consequences. Presoaking ACL grafts in vancomycin has shown to reduce postoperative SA, but its effectiveness, cost-efficiency, and adoption in clinical practice remain debated. The objectives of this study were (1) to report the incidence of SA after ACLR when using a vancomycin pre-soaked graft compared to a non-pre-soaked graft, and (2) to conduct a cost-effectiveness analysis of this procedure based on healthcare costs in France. HYPOTHESIS: Vancomycin graft presoaking would represent a cost-effective preventive strategy within the French healthcare system. PATIENTS AND METHODS: A retrospective multicenter study was conducted using the Francophone Society of Arthroscopy (SFA) registry, including primary and revision ACLR performed between November 2021 and April 2024. A total of 3,278 patients were included, of whom 2,993 (91.3%) received vancomycin-soaked grafts and 285 (8.7%) received non-soaked grafts. Postoperative complications at 6 months, including septic arthritis, were recorded. A cost-effectiveness analysis compared both strategies using the observed registry infection rate in the vancomycin group together with a literature-derived baseline infection rate and French healthcare cost estimates. RESULTS: Two cases of SA (0.07%) were identified in the vancomycin group. There was no difference between the two groups in term of SA rates (p = 1.00). Cost-effectiveness analysis demonstrated that vancomycin presoaking was a dominant strategy, with lower expected costs. Based on the assumptions of the economic model, the number needed to treat to prevent one septic arthritis was estimated at 556 patients. DISCUSSION: Vancomycin graft presoaking was associated with a very low rate of postoperative septic arthritis and appeared to be a cost-saving preventive strategy in the economic model. However, the study was not powered to demonstrate a difference in infection rates between groups. LEVEL OF EVIDENCE: III; retrospective comparative study.