Presoaking ACL Grafts in Vancomycin Decreases the Frequency of Postoperative Septic Arthritis : A Cohort Study of 29,659 Patients, Systematic Review, and Meta-analysis From the SANTI Study Group
Carrozzo, Alessandro (Centre Orthopédique Santy (França))
Saithna, Adnan (AZBSC Orthopedics (Estats Units d'Amèrica))
Ferreira, Alexandre (Centre Orthopédique Santy (França))
Guy, Sylvain (Centre Orthopédique Santy (França))
Chadli, Lamine (Centre Orthopédique Santy (França))
Monaco, Edoardo (Sapienza University of Rome)
Pérez-Prieto, Daniel (Hospital del Mar (Barcelona, Catalunya))
Bohu, Yoann (Institut de l'Appareil Locomoteur Nollet (França))
Vieira, Thais Dutra (Centre Orthopédique Santy (França))
Sonnery-Cottet, Bertrand (Centre Orthopédique Santy (França))
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Presoaking anterior cruciate ligament (ACL) grafts in vancomycin has been reported to reduce the occurrence of septic arthritis (SA). However, strong recommendations for its universal use have been precluded by concerns regarding the fragility of previous meta-analyses. The primary objective was to investigate whether presoaking ACL grafts in vancomycin was associated with a reduction in the rate of SA in a large series of patients. The secondary objective was to perform an updated systematic review and meta-analysis to determine the efficacy of vancomycin in reducing the rate of SA. Cohort study and systematic review; Level of evidence, 3. A retrospective analysis of patients who underwent primary ACL reconstruction (ACLR) at our institution was undertaken. Rates of postoperative SA were determined and analyzed according to whether patients had received grafts presoaked in vancomycin. A systematic review of the literature and meta-analysis was performed. Odds ratios (ORs) for the risk of SA were calculated according to the inverse variance approach. Results were presented using forest plots, funnel plots, and the fragility index. A total of 5300 patients underwent primary ACLR during the study period. The rate of SA was 0. 34% (11/3228) in the control group and 0. 05% (1/2072) in the presoaked group. There was a 5-fold greater risk of SA in patients who did not receive grafts presoaked in vancomycin (OR, 5. 13 [95% CI, 1. 16-48. 30]; P =. 04). Overall, 11 studies were included in the systematic review (29,659 ACLR procedures). The meta-analysis demonstrated a significantly greater risk of SA in those patients who did not receive grafts presoaked in vancomycin (OR, 14. 39 [95% CI, 5. 90-35. 10]; fragility index = 23). This finding held true for the subpopulation receiving hamstring tendon grafts (fragility index = 16), but only a trend was demonstrated for bone-patellar tendon-bone grafts. The meta-analysis demonstrated that presoaking ACL grafts in vancomycin was associated with significant reductions in the rates of SA when all graft types were analyzed together. This finding held true specifically for hamstring tendon autografts. The fragility index of these findings allows for a strong recommendation for the universal use of vancomycin presoaking. However, it should be noted that only a trend toward reduced SA rates was demonstrated with presoaking bone-patellar tendon-bone autografts in vancomycin.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Knee ; Ligaments ; ACL ; Anterior cruciate ligament reconstruction ; Septic arthritis ; Vancomycin
Published in:	Orthopaedic Journal of Sports Medicine, Vol. 10 (february 2022) , ISSN 2325-9671

DOI: 10.1177/23259671211073928
PMID: 35155711

11 p, 502.3 KB

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