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The following is a summary of “Effectiveness of a super-oxidized solution for decontaminating ACL grafts: a prospective study,” published in the February 2025 issue of the Journal of Orthopaedic Surgery and Research by Lesman et al.

Accidental contamination of anterior cruciate ligament (ACL) grafts during surgery is a critical yet understudied issue that may lead to post-operative complications. This study aimed to assess the prevalence of bacterial contamination in ACL grafts and evaluate the efficacy of Microdacyn^® as a decontamination agent. Additionally, the bacterial species identified on contaminated grafts and their antibiotic susceptibility profiles were analyzed to determine the most effective treatment options. A total of 70 patients undergoing ACL reconstruction between 2019 and 2022 were included, with exclusions for prior knee surgery or immunodeficiency to eliminate potential confounding factors. 

Grafts were categorized into three groups: (1) control, where grafts were maintained under sterile conditions; (2) contaminated, where grafts were intentionally dropped onto the operating room floor; and (3) rinsed, where contaminated grafts were subsequently decontaminated using Microdacyn^®. All grafts underwent bacteriological examination and antibiotic susceptibility testing, with statistical analysis performed using chi-square tests to assess the significance of contamination rates and decontamination effectiveness. The results revealed a contamination rate of 74.3% (52 out of 70) among grafts that had been dropped on the operating room floor, with Staphylococcus epidermidis emerging as the most frequently isolated bacterial species. 

Decontamination with Microdacyn^® significantly reduced contamination, rendering 65.7% (46 out of 70) of the previously contaminated grafts sterile. However, a notable proportion of grafts remained contaminated despite treatment, suggesting limitations in Microdacyn^®’s efficacy. Antibiotic susceptibility testing demonstrated that Staphylococcus epidermidis and other identified bacteria exhibited high sensitivity to commonly used antibiotics, including trimethoprim-sulfamethoxazole, aztreonam, and ceftazidime, which showed 97% effectiveness. Additionally, vancomycin, gentamicin, and meropenem exhibited effectiveness rates ranging from 95% to 96%. These findings highlight that while bacterial contamination of ACL grafts is a significant risk in surgical settings, effective antibiotic options remain available for treating potential infections without contributing to increased antibiotic resistance. 

Although Microdacyn^® demonstrated partial efficacy in decontaminating grafts, it was insufficient in fully eliminating bacterial contamination, underscoring the need for further research into alternative or adjunctive decontamination methods. The study emphasizes the importance of stringent intraoperative handling protocols to minimize the risk of graft contamination and reduce the likelihood of post-surgical infections. Future investigations should explore novel sterilization techniques and alternative disinfectant solutions to enhance the safety of ACL reconstruction procedures and optimize patient outcomes.

Source: josr-online.biomedcentral.com/articles/10.1186/s13018-025-05571-z