Title : Rate of autograft contamination in Anterior Cruciate Ligament (ACL) reconstruction. A systematic review and meta-analysis
Abstract:
Background: Understanding the characteristics of intra-operative graft contamination in Anterior cruciate ligament reconstruction (ACLR) may guide as to infection control measures to improve patient care. Our aim was to determine the rate and characteristics of intra-operative autograft contamination during ACLR and determine whether intra-operative contamination is related to the development of post-operative infection.
Methods: Systematic review and meta-analysis using Cochrane methodology. 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. Data was extracted using predesigned proformas and quality was assessed using the MINORS tool. Meta-analysis was conducted using a random effects model. The study was prospectively registered with PROSPERO (CRD42024570199).
Results: Literature search identified 175 records. After removing duplicates and not eligible studies, 12 studies remained. Meta-analysis showed that the estimated rate of graft contamination at any stage of the ACLR was 12.3% (CI 7.8-19%) when examining HT and BPTB grafts grouped 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 vs. harvesting showed a higher risk for the former OR 3.23 (1.01-10.39, P=0.049). Cultures were mostly monomicrobial with the most commonly identified organisms being staphylococcus epidermidis followed by staph aureus. There was no clear association between intra-operative contamination and post-operative acute overt infection, but the evidence assessing this parameter was sparse and any link to chronic low-grade infection was not evaluated.
Conclusion: There is a high rate of autograft contamination during ACLR and infection prevention measures need to take this into consideration. The association between contamination with chronic low-grade infection and risk of graft re-rupture remains to be evaluated.
