Evidence map›Paper›PMID 30666370›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2019

Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction.

Christoph Offerhaus, Maurice Balke, Juliane Hente, Mats Gehling, Simon Blendl, Jürgen Höher

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Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
50citing papers in PubMed, 3 pooled it
12.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 102 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Christoph OfferhausSportsclinic Cologne, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany.ORCID http://orcid.org/0000-0003-2711-6559
Maurice BalkeSportsclinic Cologne, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany.
Juliane HenteFaculty of Health, Witten/Herdecke University, Witten, Germany.
Mats GehlingFaculty of Health, Witten/Herdecke University, Witten, Germany.
Simon BlendlFaculty of Health, Witten/Herdecke University, Witten, Germany.
Jürgen HöherSportsclinic Cologne, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Straße 200, 51109, Cologne, Germany. hoeher@sporttrauma-koeln.de.
Witten/Herdecke University · DEGerman Sport University Cologne · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo investigate whether pre-soaking the graft in vancomycin during anterior cruciate ligament reconstruction (ACLR) reduces the postoperative infection rate and if this technique is associated with an increased rate of complications, including graft failure or arthrofibrosis.

methodsA retrospective review of a prospective database was performed in 1779 patients who underwent ACLR over a period of 5 years, analysing the rate of postoperative deep knee infection. Group 1 and 2 both received perioperative IV antibiotics, while only group 2 underwent ACLR with grafts pre-soaked in a 5 mg/ml vancomycin solution. To analyse possible side effects associated with vancomycin use, 500 patients out of the overall study population (100 patients per year) were randomly selected and retrospectively interviewed for further postoperative complications including graft failure and arthrofibrosis as well as subjective evaluation of their knee by completing the IKDC form with a minimum mean follow-up of 37 months.

resultsIn group 1, 22 out of 926 (2%) patients suffered a postoperative deep knee infection. In contrast, there were no postoperative infections in the second group of 853 patients (0%). 16 of 22 infections (73%) were caused by coagulase-negative Staphylococcus. Statistical analysis revealed a significantly reduced postoperative infection rate when bathing the autograft in vancomycin (p < 0.01). Analysis of the random sample revealed a significant decrease of graft failure with 8 reruptures in 257 patients (3%) in the vancomycin group compared to 16 cases of graft failure in 167 patients (10%) in the control group (p < 0.05). No differences were found in the rate of postoperative arthrofibrosis, Tegner or subjective outcome scores.

conclusionProphylactic vancomycin pre-soaking of autografts during ACLR appears to be a viable, cost-effective and safe option to reduce the rate of deep infection compared to systemic antibiotics alone. LEVEL OF EVIDENCE: III.

Indexed as

AdultAnterior Cruciate Ligament InjuriesAnterior Cruciate Ligament ReconstructionAnti-Bacterial AgentsAutograftsFemaleGraft RejectionHumansJoint DiseasesKnee JointMaleMiddle AgedPostoperative ComplicationsProspective StudiesRetrospective StudiesSurgical Wound InfectionAnti-Bacterial AgentsVancomycinAnterior cruciate ligamentAntibiotic prophylaxisArthrofibrosisGraft failureKnee infectionVancomycin

Identifiers

PMID30666370
OpenAlexW2913881017

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.