AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-I Just Dropped My Graft on the OR Floor! Now What

I Just Dropped My Graft on the OR Floor! Now What_-Aman Dhawan, M.D.

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This presentation by Aman Dhawan, MD, addresses the management of a dropped anterior cruciate ligament (ACL) graft during reconstruction surgery. Dropping the graft on the floor, while shocking for surgeons, is a common occurrence—88% of sports medicine surgeons have experienced at least one contaminated graft. The key is to remain calm and focus on managing the situation effectively rather than reacting emotionally.<br /><br />Surgeons have three primary options when faced with a dropped graft: clean/sterilize the graft, use a different graft source, or rely on an allograft. Studies have shown that graft cleansing and reutilization is common and safe, with no reported infections following proper sterilization protocols.<br /><br />The optimal sterilization method involves chlorhexidine solutions. Research indicates that soaking the graft in 2%-4% chlorhexidine for durations between 8 to 30 minutes plus mechanical agitation and rinsing with antibiotic solutions leads to 95-100% sterilization efficacy. For example, an effective protocol includes 8 minutes of irrigation with 3 liters of 2% chlorhexidine, followed by antibiotic rinses and saline wash. However, chlorhexidine use requires careful rinsing to avoid potential chondrolysis (cartilage damage).<br /><br />Preventative strategies include having the surgeon personally transport the harvested graft to the back table, wrapping it in a saline-soaked sponge, and placing it inside a sealed specimen container. This setup helps retrieve the graft sterilely even if dropped.<br /><br />In summary, dropped ACL grafts, though distressing, can be safely managed with proper protocols emphasizing chlorhexidine sterilization. Surgeons should remain composed, communicate transparently with patients, and adopt preventive measures to minimize risks and maintain surgical safety and outcomes.

Keywords

ACL graft

anterior cruciate ligament

graft contamination

chlorhexidine sterilization

sports medicine surgery

graft cleaning protocol

allograft use

surgical graft handling

infection prevention

chondrolysis risk