Graft salvage following infected anterior cruciate ligament reconstruction A SYSTEMATIC REVIEW AND META-ANALYSIS

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.