Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, U.S.A.
Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California, U.S.A..
Arthroscopy. 2021 May;37(5):1683-1690. doi: 10.1016/j.arthro.2020.12.212. Epub 2020 Dec 24.
To compare postoperative infection rates following ACL reconstruction performed with grafts presoaked in vancomycin versus those without vancomycin.
A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for therapeutic level I to III studies that compared outcomes of presoaking ACL grafts with vancomycin versus without vancomycin in human patients. Included graft types were tendon autografts or allografts, and included studies documented infection with a minimum follow-up of 30 days. Postoperative infection rates and knee-specific patient-reported outcome scores were extracted from each study and compared between groups. Study methodological quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Coleman Methodology Score (MCMS). Infection rates and retear rates were pooled and weighted for meta-analysis using a random-effects model. All P values were reported with an α level of 0.05 set as significant.
The initial search yielded 144 articles (44 duplicates, 100 screened, 29 full-text review). Ten articles (21,368 subjects [7,507 vancomycin and 13,861 no vancomycin], 67% males, mean ± standard deviation age 29.5 ± 1.5 years) were included and analyzed. Eight of the 10 studies included only autografts, with 94.5% of grafts being hamstring autografts. Soaking grafts in vancomycin resulted in significantly fewer infections (0.013% versus 0.77%; odds ratio 0.07; 95% confidence interval 0.03, 0.18; P < .001). Only 2 studies included patient-reported outcomes, and both demonstrated no difference in International Knee Documentation Committee scores 1 year after surgery for patients with grafts presoaked in vancomycin versus without vancomycin.
Soaking ACL tendon grafts with vancomycin before implantation is associated with a nearly 15 times decrease in odds of infection compared with grafts not soaked in vancomycin. Few studies investigated patient-reported outcomes and retear rates after soaking ACL grafts in vancomycin.
III, systematic review of level III studies.
比较 ACL 重建术后使用万古霉素浸泡移植物与不使用万古霉素的感染率。
采用 PRISMA 指南进行系统评价。检索 PubMed、SCOPUS 和 Cochrane 对照试验中心注册库，以获取比较 ACL 移植物用万古霉素浸泡与未浸泡的治疗水平 I 至 III 研究。纳入的移植物类型为肌腱自体移植物或同种异体移植物，纳入的研究均记录了至少 30 天随访的感染情况。从每项研究中提取术后感染率和膝关节特定患者报告的结果评分，并在组间进行比较。使用非随机研究方法学指数（MINORS）和改良 Coleman 方法学评分（MCMS）分析研究方法学质量。使用随机效应模型对感染率和再撕裂率进行汇总和加权进行荟萃分析。所有 P 值均报告，设定 0.05 为显著性水平。
最初的搜索结果产生了 144 篇文章（44 篇重复，100 篇筛选，29 篇全文审查）。纳入并分析了 10 篇文章（21368 例受试者[7507 例万古霉素组和 13861 例无万古霉素组]，67%为男性，平均±标准差年龄 29.5±1.5 岁）。10 篇研究中有 8 篇仅纳入自体移植物，94.5%的移植物为腘绳肌腱自体移植物。万古霉素浸泡移植物可显著降低感染率（0.013%比 0.77%；比值比 0.07；95%置信区间 0.03，0.18；P<0.001）。仅有 2 项研究纳入了患者报告的结局，这两项研究均表明，在接受 ACL 移植物浸泡万古霉素和未浸泡万古霉素的患者中，术后 1 年的国际膝关节文献委员会评分无差异。
与未浸泡万古霉素的移植物相比，ACL 肌腱移植物在植入前用万古霉素浸泡可使感染几率降低近 15 倍。很少有研究调查浸泡 ACL 移植物后患者报告的结局和再撕裂率。
III，III 级研究的系统评价。
