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 what to do if an anterior cruciate ligament (ACL) graft is dropped and contaminated during surgery. Although it is a stressful and unexpected event, surveys show that 88% of sports medicine surgeons have experienced dropped graft contamination, so it is a common issue that can be managed effectively.<br /><br />The immediate response should be to remain calm and focus on the situation rather than react emotionally. The surgeon has three main options: clean and sterilize the graft, use a different autograft source, or switch to an allograft. Data from a 2005 Arthroscopy study indicate that 75% of contaminated grafts were successfully salvaged through cleansing, with no reported infections.<br /><br />Chlorhexidine is identified as the optimal agent for sterilizing dropped grafts, outperforming other antiseptics like polymyxin B, bacitracin, iodine, or saline. Effective sterilization protocols include an 8-minute irrigation with 3 liters of 2% chlorhexidine combined with mechanical agitation and subsequent rinses with antibiotic solutions, or a 30-minute soak in 4% chlorhexidine followed by triple antibiotic soaks. These protocols achieve near 100% sterilization of grafts. However, chlorhexidine must be thoroughly rinsed off afterward to prevent chondrolysis.<br /><br />Prevention is also key: the surgeon should personally deliver the harvested graft to the back table, storing it wrapped in a saline-soaked sponge inside a sealed specimen container. If dropped, the graft can then be retrieved in a sterile manner from the container.<br /><br />In summary, dropped graft contamination is common but manageable with calm, protocol-driven care using chlorhexidine sterilization. Open communication with the patient and family about the incident is also essential. This approach minimizes infection risk and allows the surgery to proceed safely.

Keywords

anterior cruciate ligament

ACL graft contamination

graft sterilization

chlorhexidine

sports medicine surgery

dropped graft management

autograft

allograft

infection prevention

surgical protocols