Surgical Time Is More Predictive of Suture Contamination During Arthroscopic Rotator Cuff Repair Compared With Skin-Preparation Method: A Prospective Randomized Study on Male Patients.

Abstract

To compare 3 antiseptics and to identify factors associated with suture contamination during arthroscopic rotator cuff repair. One hundred fifty male patients scheduled for rotator cuff repair between July 2021 and October 2022 were enrolled. Patients were randomly assigned to 1 of 3 antiseptics groups: povidone-iodine (P), alcohol-containing povidone-iodine (AP), and olanexidine gluconate (O). To minimize variability in surgical duration, surgeons were categorized into 3 groups (A, shortest; B, intermediate; C, longest) based on their preliminary average surgical time, and 1 of 3 antiseptics was randomly assigned to each group. Sutures cut after the last medial knot tying were cultured for a maximum of 3 weeks. The positive rates of Cutibacterium acnes and miscellaneous bacteria were compared between antiseptics and surgeon groups. Repair integrity was evaluated via postoperative magnetic resonance imaging, and its relation with contamination was assessed. C. acnes was detected in 92 shoulders (61%) and miscellaneous bacteria in 34 shoulders (23%), with coagulase-negative Staphylococcus predominating. There were no significant differences in the C. acnes-positive rates between the antiseptics groups. The contamination rate for any bacteria was significantly lower in AP than in O. Logistic regression analysis showed that O had a higher risk of any bacterial contamination than AP (odds ratio, 3.82; P = .013). Shorter surgical and suture exposure times were associated with lower contamination rates. No relation was found between contamination and retear. C. acnes was the most commonly detected bacterium in suture contamination during arthroscopic rotator cuff repairs. There was no difference in the efficacy of the 3 disinfectants in preventing C. acnes contamination; however, the overall bacterial contamination rate was significantly higher in olanexidine compared with alcohol-containing povidone-iodine. Shorter surgical and suture exposure times were associated with a lower incidence of suture contamination. Level I, prospective randomized study.