Abstract
During anterior cruciate ligament (ACL) reconstruction, intraoperative graft contamination
or postoperative infection remains a notable clinical concern. While antiseptic solutions
are increasingly employed for graft decontamination and infection prophylaxis, the
potential impact of these agents on the biomechanical integrity of tendon grafts has
not been fully elucidated. This experimental study aimed to evaluate the biomechanical
effects of soaking tendon grafts in vancomycin, chlorhexidine, and povidone-iodine
solutions. Fresh bovine deep digital flexor tendons were used to simulate ACL autografts
and randomly assigned to four groups (n = 6): 4% chlorhexidine, 10% povidone-iodine, 5 mg/mL vancomycin, and 0.9% isotonic
saline (control). After 30-minute soaking, tendons were sutured using a four-rip-stop
technique and biomechanically tested using a servohydraulic tensile system. Failure
load, stiffness, and cyclic elongation were measured. Statistical analysis was performed
using Kruskal–Wallis and Mann–Whitney U tests with Bonferroni correction. Vancomycin
and chlorhexidine groups exhibited significantly lower cyclic elongation compared
to control and povidone-iodine groups. Failure load was also significantly higher
in these groups, particularly compared to povidone-iodine, which demonstrated the
weakest biomechanical performance. No significant differences in stiffness were observed
across groups. Vancomycin and chlorhexidine can be safely used for short-term antiseptic
soaking without compromising graft mechanical integrity. In contrast, povidone-iodine
may weaken tendon structure. These findings may guide antiseptic use during ACL reconstruction
and in managing contaminated tendons in open injuries.
Keywords
ACL reconstruction - autograft - tendon soaking - vancomycin - chlorhexidine - povidone-iodine
- biomechanics
