When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy

- Inadvertent contamination of the autograft could occur during ACL reconstruction.
- A chlorhexidine gluconate solution is efficient to reduce contamination of the graft.
- A povidone-iodine solution is efficient to reduce contamination of the graft.
- Soaking of the graft in theses solutions is recommended in case of contamination.

BackgroundInadvertent contamination of the autograft can occur during anterior cruciate ligament (ACL) reconstruction if the autograft is dropped on the floor during surgery. A study was undertaken to determine the incidence of contamination when a graft is dropped on the operating room floor and the efficacy of antimicrobial solutions to decontaminate it.MethodsSamples from 25 patients undergoing ACL reconstruction with a hamstring tendon were sectioned and dropped onto the floor. Cultures were taken after immersion in antiseptic solutions (a chlorhexidine gluconate solution (group 1), a povidone-iodine solution (group 2), and a sodium hypochlorite solution (group 3)). A fourth piece (group 0) was cultured without being exposed to any solution. Cultures of a floor swab were taken at the same time.ResultsThe floor swab cultures were positive in 96% of cases. The rate of contamination was 40% in group 0, 8% in group 1, 4% in group 2, and 16% in group 3. There was a significant difference between groups 1 and 2 and group 0 (p < 0.05) but not between groups 3 and 0.ConclusionsImmersing a graft dropped on the floor during surgery in a chlorhexidine gluconate solution or povidone-iodine solution significantly reduces contamination of the graft. Soaking of the hamstring autograft in one of these solutions is recommended in the case of inadvertent contamination.Clinical relevanceLaboratory investigation (level 2).