Vancomycin-Soaked Quadriceps Grafts Linked to Early Resorption in ACLR: study

Anterior cruciate ligament (ACL) injuries are among the most common orthopedic injuries. While Hamstring Tendon (HT) autograft reconstructions have been the most frequent graft type over the last decade, quadriceps tendon (QT) autografts have become increasingly popular in the past few years. The procedure of vancomycin graft soaking has become the state-of-the-art in many institutions as it avoids septic knee arthritis after anterior cruciate ligament reconstruction (ACLR).

Patrick Weninger et al analyzed all patients presenting with an ACL rupture who subsequently underwent primary ACLR using either HT or QT autografts soaked in vancomycin during a 12-month study period. They specifically focused on the occurrence of graft resorption leading to early graft failure, comparing outcomes between HT and QT autografts.

Relevant data of all patients presenting with a primary anterior cruciate ligament (ACL) rupture and subsequently undergoing ACL reconstruction (ACLR) using either a hamstring tendon (HT) or quadriceps tendon (QT) autograft were collected. Patients who later presented to our outpatient clinic with clinical signs of recurrent knee instability, with or without a preceding trauma, underwent magnetic resonance imaging (MRI) to evaluate graft integrity.

Early graft failure was defined as recurrent instability within 12 months after the index ACLR, confirmed by MRI evidence of an absent or nonfunctional graft, and if revision surgery was performed arthroscopic confirmation of graft absence.

The key findings of the study were:

• A total of 468 patients underwent anterior cruciate ligament reconstruction (ACLR) using autografts, including 421 hamstring tendon (HT) and 47 quadriceps tendon (QT) grafts.

• During the 12-month follow-up period, early graft failure occurred in 22 patients (all QT autografts), corresponding to a failure rate of 46.8% in the QT group and 0% in the HT group.

• Nineteen of the affected patients underwent revision ACLR, while three declined further surgery.

The authors concluded – “The markedly higher rate of early graft failure due to graft resorption observed in the QT group raises concern regarding the safety of combining vancomycin soaking with quadriceps tendon autografts for ACL reconstruction. Given the proven infection-preventive benefit of vancomycin and the lack of data specifically addressing QT autografts, these findings should be interpreted with caution and considered hypothesis-generating. Until further evidence becomes available, surgeons should exercise caution when using vancomycin-soaked QT autografts, while the combination of hamstring tendon autografts with vancomycin remains the more established and better-studied option. Prospective clinical and experimental studies are needed to confirm these observations and clarify the underlying mechanisms.”

For further details on the article refer to:

Vancomycin-Soaked Quadriceps Tendon Autografts but Not Hamstring Tendon Autografts Are Associated with Early Graft Failure (Graft Resorption) After Primary Anterior Cruciate Ligament Reconstruction: A Single-Center Experience

Patrick Weninger et al

Indian Journal of Orthopaedics (2026) 60:672–677

https://doi.org/10.1007/s43465-025-01632-x