Graft salvage following infected anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

ABSTRACT

AIMS: To examine the rates of hamstring graft salvage with arthroscopic debridement of infected anterior cruciate ligament (ACL) reconstruction as reported in the literature and discuss functional outcomes. MATERIALS AND METHODS: A search was performed without language restriction on PubMed, EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials (CENTRAL) databases from their inception to April 2015. We identified 147 infected hamstring grafts across 16 included studies. Meta-analysis was performed using a random-effects model to estimate the overall graft salvage rate, incorporating two different definitions of graft salvage. RESULTS: The graft salvage rate was 86% (95% confidence intervals (CI) 73% to 93%; heterogeneity tau(2) = 1.047, I(2) = 40.51%, Q = 25.2, df = 15, p < 0.001), excluding ACL re-ruptures. Including re-ruptures as failures, the graft salvage rate was 85% (95% CI 76% to 91%; heterogeneity tau(2) = 0.099, I(2) = 8.15%, Q = 14.15, df = 13, p = 0.36). CONCLUSIONS: Arthroscopic debridement combined with antibiotic treatment can lead to successful eradication of infection and graft salvage, with satisfactory functional outcomes in many cases of septic arthritis following ACL reconstruction. Persistent infection despite repeat arthroscopic debridements requires graft removal with the intention of revision ACL surgery at a later stage. TAKE HOME MESSAGE Arthroscopic debridement combined with antibiotic therapy is an appropriate initial approach in most cases of septic arthritis following ACL reconstruction, achieving graft salvage rates of about 85%. Cite this article Bone Joint J 2016;98-B608-15.