Glove Perforation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Silent Culprit of Infection

With the growing popularity of sports, the number of arthroscopic anterior cruciate ligament (ACL) reconstructions has steadily increased. Although postoperative infection rates after arthroscopy are relatively low (0.28–1.0%), they can cause significant complications, particularly in young and active patients. One overlooked factor is glove perforation, which may contaminate the surgical field and allow infection to pass between the surgical team and the patient. This study aimed to determine the incidence of glove perforation during arthroscopic ACL reconstruction. A prospective single-center study was conducted between August 2 and October 1, 2024. Gloves used by the primary surgeon, assistant surgeon, and scrub nurse were collected after ACL reconstruction procedures. All operations employed the anatomical single bundle technique with hamstring tendons. Perforations were detected by filling the gloves with water mixed with food coloring and applying pressure to reveal leaks. In total, 43 surgeries were evaluated. Glove perforation was identified in 44.2% of procedures. The second surgeon had the highest perforation rate (68.7%), while scrub nurses demonstrated the greatest overall incidence (52.6%). The most frequent stage for glove perforation occurred during the opening of bone tunnels (47.4%). In conclusion, glove perforation is common in arthroscopic ACL reconstruction, largely due to the use of sharp surgical instruments. Routine glove changes after 90 minutes and careful handling of penetrating tools are recommended to minimize infection risks and prevent septic arthritis.