Title : Evaluation of autograft contamination in Anterior Cruciate Ligament Reconstruction (ACLR) and its clinical impact; A systematic review and meta-analysis
Abstract:
Background: Understanding the characteristics of intra-operative graft contamination (IOGC) in anterior cruciate ligament reconstruction (ACLR) may guide infection control measures. Aim: To determine the rate and characteristics of intra-operative graft contamination during ACLR and its clinical impact in relation to the development of post-operative infection.
Methods: A systematic review and meta-analysis using Cochrane methodology was performed. PubMed, Embase, CINAHL, and Cochrane CENTRAL were searched. Studies reporting on the rate of autograft contamination, hamstring tendon (HT) or bone patellar tendon bone (BPTB) grafts, during ACLR were included. Meta-analysis was conducted using a random effects model. The study was prospectively registered with PROSPERO (CRD42024570199).
Results: Literature search identified 175 studies. After removing duplicates and ineligible studies, 12 qualified for evaluation. Meta-analysis showed that the estimated rate of graft contamination during ACLR was 12.3% (CI 7.8-19%) when examining HT and BPTB grafts together. Similar rates were observed when examining HT and BPTB grafts in isolation (11.9%, CI 7.2-18.9, versus 14%, CI 7.1-25.6%,). Meta-analysis of two studies that directly compared contamination between the preparation stage versus harvesting stage showed a higher risk for the former OR 3.23 (1.01-10.39, P=0.049). Cultures were mostly monomicrobial and Staphylococcus Epidermidis was the most commonly isolated organism. There was no clear association between IOGC and post operative full-blown infection, but the evidence assessing this parameter was sparse and any link to chronic low-grade infection could not established.
Conclusion: There is a high rate of autograft contamination during ACLR and elaborate infection prevention measures are required to reduce this.
