Vancomycin Graft Presoaking in Anterior Cruciate Ligament Reconstruction Surgery Is Associated with a Lower Risk of Graft Rerupture as Compared With No Vancomycin Presoaking: Systematic Review and Meta-analysis.

IF 1.7 Q2 SURGERY JBJS Reviews Pub Date : 2023-12-20 eCollection Date: 2023-12-01 DOI:10.2106/JBJS.RVW.23.00145

Charalambos P Charalambous, Emadeldin M Ahmed, Fatima Kayali, Hritik Nautiyal, Kenan Kuršumović, Paul M Sutton

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Abstract

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.

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前十字韧带重建手术中万古霉素移植物预浸泡与不预浸泡万古霉素相比，移植物再断裂的风险更低：系统综述与元分析》。

背景：目的：确定在前交叉韧带（ACL）重建术（ACLR）中进行万古霉素移植物预浸泡与不进行万古霉素预浸泡的病例在移植物断裂率和临床结果方面是否存在差异：系统回顾和荟萃分析。检索了 PubMed、Embase、CINAHL 和 Cochrane CENTRAL。纳入了报道万古霉素移植物预浸泡与前交叉韧带重建手术中移植物断裂率和/或临床结果之间关系的已发表完整研究，以及未进行万古霉素移植物预浸泡的研究。进行了数据提取和质量评估。采用随机效应模型进行 Meta 分析。研究方案已在 PROSPERO（CRD42021290608）进行了前瞻性注册：文献检索共发现 907 条记录。剔除重复和不符合纳入标准的研究后，共纳入 8 项研究。Meta 分析显示，使用万古霉素预浸泡的病例与未预浸泡的病例相比，腘绳肌移植物再断裂的估计风险较低（再断裂率分别为 3.2% 和 6.2%，风险比 [RR] = 0.507，95% CI，0.39-0.737，P <0.001）。同样，当分析包括各种前交叉韧带移植物类型时，用万古霉素预浸泡的病例与未预浸泡的病例相比，移植物破裂的估计风险较低（2.7% 与 3.9% 的破裂率，RR = 0.557，95% 置信区间 [CI]，0.403-0.771，P < 0.001）。Meta 分析还显示，与不进行预浸泡相比，在腘绳肌移植物方面（估计平均差异为 0.112，95% CI，-2.359 至 2.582，p = 0.929）或在考虑各种移植物类型时（估计平均差异为 0.933，95% CI，-0.140 至 2.006，p = 0.088），万古霉素移植物预浸泡与国际膝关节文献委员会的评分相似：结论：万古霉素移植物预浸泡是一种安全的做法，不会影响前交叉韧带移植物的再断裂率或临床效果：证据等级：IV级。有关证据等级的完整描述，请参阅 "作者须知"。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.