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Vancomycin Graft Presoaking in Anterior Cruciate Ligament Reconstruction Surgery Is Associated with a Lower Risk of
Charalambos P Charalambous1,2, Emadeldin M Ahmed2, Fatima Kayali3
1School of Medicine, University of Central, Lancashire, United Kingdom.
Background:
To determine whether there is any difference in graft rerupture rates and clinical outcomes between cases having vancomycin graft presoaking vs. no vancomycin presoaking in anterior cruciate ligament (ACL) reconstruction (ACLR).
Methods:
Systematic review and meta-analysis. PubMed, Embase, CINAHL, and Cochrane CENTRAL were searched. Full published studies reporting on the relation between vancomycin graft presoaking and rates of graft rerupture and/or clinical outcomes in ACLR surgery vs. no vancomycin graft presoaking were included. Data extraction and quality appraisal were performed. Meta-analysis was conducted using a random effects model. The study's protocol was prospectively registered with PROSPERO (CRD42021290608).
Results:
The literature search identified 907 records. After removing duplicates and those not meeting inclusion criteria, 8 studies were included. Meta-analysis showed that the estimated risk of hamstring graft rerupture was lower in cases presoaked with vancomycin vs. those having no presoaking (3.2% vs. 6.2% rerupture rate, risk ratio [RR] = 0.507, 95% CI, 0.39-0.737, p < 0.001). Similarly, the estimated risk of graft rerupture was lower in cases presoaked with vancomycin vs. those having no presoaking when the analysis included various ACL graft types (2.7% vs. 3.9% rerupture rate, RR = 0.557, 95% confidence interval [CI], 0.403-0.771, p < 0.001). Meta-analysis also showed that vancomycin graft presoaking was associated with similar International Knee Documentation Committee scores as compared with no presoaking when looking at hamstring grafts (estimated mean difference 0.112, 95% CI, -2.359 to 2.582, p = 0.929) or when considering various graft types (estimated mean difference 0.933, 95% CI, -0.140 to 2.006, p = 0.088).
Conclusion:
Vancomycin graft presoaking is a safe practice and does not compromise ACL graft rerupture rates or clinical outcomes.
Level Of Evidence:
Level IV. See Instructions for Authors for a complete description of levels of evidence.
Insights
Vancomycin graft presoaking in anterior cruciate ligament (ACL) reconstruction reduces graft rerupture risk without negatively impacting clinical outcomes. This safe practice enhances ACLR surgery results.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Clinical Research
Background:
- Anterior cruciate ligament (ACL) reconstruction (ACLR) is a common orthopedic procedure.
- Graft choice and preparation are critical for successful ACLR outcomes.
- The role of vancomycin graft presoaking in ACLR remains a subject of investigation.
Conclusions:
- Vancomycin graft presoaking is a safe adjunct in ACL reconstruction.
- This practice does not compromise graft integrity or patient outcomes.
- Vancomycin presoaking may contribute to reduced graft rerupture rates in ACLR.
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