{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:11:20Z","timestamp":1790604680402,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"\n Purpose<\/jats:title>\n To examine systemic exposure and elution characteristics of liquid vancomycin\u2010soaked anterior cruciate ligament (ACL) grafts in vivo by assessing serum vancomycin levels over 48\u2009hours after ACL reconstruction and comparing the resulting concentrations with the toxic threshold of 15 to 20\u2009\u03bcg\/mL.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients consenting between October 2023 and January 2024 and undergoing isolated ACL reconstruction or 2\u2010stage revision after tunnel bone grafting were included. Hamstring or quadriceps grafts were used, with or without meniscal surgery. Six blood samples were taken, first preoperatively and second 10\u2009minutes after tourniquet release and each at 1, 6 to 8, 24, and 48\u2009hours. Soaking time was measured. Vancomycin concentrations were analyzed by tandem mass spectrometry and high\u2010performance liquid chromatography. Spearman rho correlation coefficients were used to identify relations between the parameters. A\n P<\/jats:italic>\n value of <.05 was considered statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study included 21 patients (17 men, 4 women, median age: 36, interquartile range [IQR] 16). The highest median levels of vancomycin detectable in peripheral blood were observed both 6 to 8\u2009hours (0.0050\u2009\u03bcg\/mL, IQR 0.0079\u2009\u03bcg\/mL) and 24\u2009hours (0.0050\u2009\u03bcg\/mL, IQR 0.0144\u2009\u03bcg\/mL) postoperatively. After 48\u2009hours, a median concentration of 0.0021\u2009\u03bcg\/mL (IQR 0.0032\u2009\u03bcg\/mL) could still be detected. The maximum serum concentration of vancomycin in all samples was 0.704\u2009\u03bcg\/mL. Significant correlation was found between the soaking time and measured maximum vancomycin serum concentrations (\n r<\/jats:italic>\n \u2009=\u20090.497;\n P<\/jats:italic>\n \u2009=\u2009.022).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Systemic vancomycin concentrations after implantation of a liquid vancomycin\u2010soaked ACL graft remained well below the established toxic threshold for adverse effects. Additionally, peak systemic concentrations occurred 6 to 24\u2009hours postoperatively, with graft soaking time identified as a factor that significantly influenced systemic levels.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level IV, prospective case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/arj.70606","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:42:55Z","timestamp":1790602975000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peak Serum Vancomycin Levels Are Achieved Between 6 and 24 Hours After Implantation of Vancomycin\u2010Soaked Anterior Cruciate Ligament Grafts"],"prefix":"10.1002","author":[{"given":"Swen","family":"Witteveen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9088-334X","authenticated-orcid":false,"given":"Steffen T.","family":"Ubl","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0373-3715","authenticated-orcid":false,"given":"Sophia","family":"Krombholz","sequence":"additional","affiliation":[{"name":"Center for Preventive Doping Research, Institute of Biochemistry German Sport University Cologne Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3397-5643","authenticated-orcid":false,"given":"Daniel","family":"Guenther","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolin","family":"Flieser","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6265-9802","authenticated-orcid":false,"given":"Arasch","family":"Wafaisade","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5048-1311","authenticated-orcid":false,"given":"Bertil","family":"Bouillon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5972-8854","authenticated-orcid":false,"given":"Mario","family":"Thevis","sequence":"additional","affiliation":[{"name":"Center for Preventive Doping Research, Institute of Biochemistry German Sport University Cologne Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0492-6949","authenticated-orcid":false,"given":"Thomas R.","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center Witten\/Herdecke University Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"232596712312008","DOI":"10.1177\/23259671231200822","article-title":"A systematic review and meta\u2010analysis of risk factors for an infection after anterior cruciate ligament reconstruction","volume":"11","author":"Zhang L","year":"2023","journal-title":"Orthop J Sports Med."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"2844","DOI":"10.1007\/s00167-012-2264-3","article-title":"Knee joint infection after ACL reconstruction: Prevalence, management and functional outcomes","volume":"21","author":"Torres\u2010Claramunt R","year":"2013","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1016\/j.arthro.2014.12.026","article-title":"Functional outcome and graft retention in patients 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decrease the risk of infection after anterior cruciate ligament reconstruction","volume":"28","author":"Vertullo CJ","year":"2012","journal-title":"Arthroscopy."},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1186\/s12891-023-06331-y","article-title":"Vancomycin presoak reduces infection in anterior cruciate ligament reconstruction: A systematic review and meta\u2010analysis","volume":"24","author":"Hu M","year":"2023","journal-title":"BMC Musculoskelet Disord."},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"e1900156","DOI":"10.2106\/JBJS.RVW.19.00156","article-title":"Relationship of graft type and vancomycin presoaking to rate of infection in anterior cruciate ligament reconstruction: A meta\u2010analysis of 198 studies with 68,453 grafts","volume":"8","author":"Kursumovic K","year":"2020","journal-title":"JBJS 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