Mustamsir Edi, Aulia Pandu Aji, Fernando Alexander
Department of Orthopaedic and Traumatology, Brawijaya University Faculty of Medicine, Saiful Anwar State General Hospital, Malang, Indonesia.
Brawijaya University Faculty of Medicine, Malang, Indonesia.
Acta Orthop Traumatol Turc. 2025 Mar 17;59(1):7-17. doi: 10.5152/j.aott.2025.24070.
This meta-analysis aimed to evaluate the e!ectiveness of arthroscopic irrigation and debridement in the management of septic arthritis following anterior cruciate ligament reconstruction (ACL-R), with a focus on graft retention rates, functional outcomes, and the microbiological profile of infections.
This meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024562550). PubMed, Cochrane, ProQuest, and ScienceDirect databases were searched for studies published before July 2024 using predefined Medical Subject Headings terms and keywords related to ACL-R infections and arthroscopic irrigation and debridement. Inclusion criteria followed the PICO framework: Population (patients with septic arthritis following ACL-R), intervention (arthroscopic irrigation and debridement), comparator (none), and outcomes (graft retention rate, Lysholm Knee Score, International Knee Documentation Committee [IKD] score, and Tegner Activity Scale [TAS], and microbiology data). The risk of bias was assessed using the Cochrane Risk of Bias in Non-Randomized Studies-of Interventions. Meta-analyses were performed using R Studio, with results presented as pooled proportions or means with 95% confidence intervals (95% CI).
A total of 20 studies involving 333 patients were analyzed, with follow-up periods ranging from 18 days to 67 months. The pooled graft retention rate was 92% (95% CI [88-94%]), confirmed by proportional meta-analysis with low heterogeneity (I"=0%, P=2.0948). Functional knee outcomes showed pooled mean scores of 82.41 for Lysholm (95% CI [78.15-86.66], I"=87.3%-92.7%), 79.37 for IKDC (95% CI [74.00-84.75], I"=68.3%-82.2%), and 5.08 for TAS (95% CI [4.87-5.30], I"=0%-52.6%), indicating moderate to satisfactory recovery. Coagulase-negative Staphylococcus (42.34%) and Staphylococcus aureus (23.12%) were the most frequently isolated pathogens, with 9.91% of cases involving antibiotic-resistant strains, including MRSA (4.50%) and MR-CNS (5.41%). Cephalosporin or vancomycin was the most commonly administered first-line antibiotic, often combined with other agents.
The findings suggest that arthroscopic irrigation and debridement, combined with appropriate antibiotic therapy, are e!ective in managing septic arthritis following ACL-R, achieving a high graft retention rate of 92% and moderate to satisfactory functional outcomes. However, the presence of antibiotic-resistant pathogens and challenges in returning to high-level sports highlight the importance of preventive measures to protect athlete performance and recovery.
Level IV, Therapeutic Study.
本荟萃分析旨在评估关节镜冲洗清创术在前交叉韧带重建（ACL-R）术后感染性关节炎治疗中的有效性，重点关注移植物保留率、功能结局以及感染的微生物学特征。
本荟萃分析遵循PRISMA指南，并在PROSPERO（CRD42024562550）注册。使用预定义的医学主题词和与ACL-R感染以及关节镜冲洗清创术相关的关键词，在PubMed、Cochrane、ProQuest和ScienceDirect数据库中检索2024年7月之前发表的研究。纳入标准遵循PICO框架：人群（ACL-R术后感染性关节炎患者）、干预措施（关节镜冲洗清创术）、对照（无）以及结局指标（移植物保留率、Lysholm膝关节评分、国际膝关节文献委员会[IKD]评分、Tegner活动量表[TAS]以及微生物学数据）。使用Cochrane非随机干预研究偏倚风险评估工具评估偏倚风险。使用R Studio进行荟萃分析，结果以合并比例或均值及95%置信区间（95%CI）呈现。
共分析了20项研究，涉及333例患者，随访期从18天至67个月。合并移植物保留率为92%（95%CI[88-94%]），通过低异质性（I²=0%，P=2.0948）的比例荟萃分析得到证实。膝关节功能结局显示，Lysholm评分合并均值为82.41（95%CI[78.15-86.66]，I²=87.3%-92.7%），IKDC评分为79.37（95%CI[74.00-84.75]，I²=68.3%-82.2%），TAS评分为5.08（95%CI[4.87-5.30]，I²=0%-52.6%），表明恢复程度为中度至满意。凝固酶阴性葡萄球菌（42.34%）和金黄色葡萄球菌（23.12%）是最常见的分离病原体，9.91%的病例涉及耐药菌株，包括耐甲氧西林金黄色葡萄球菌（MRSA，4.50%）和耐甲氧西林凝固酶阴性葡萄球菌（MR-CNS，5.41%）。头孢菌素或万古霉素是最常用的一线抗生素，常与其他药物联合使用。
研究结果表明，关节镜冲洗清创术联合适当的抗生素治疗在ACL-R术后感染性关节炎治疗中有效，移植物保留率高达92%，功能结局为中度至满意。然而，耐药病原体的存在以及恢复高水平运动的挑战凸显了预防措施对保护运动员表现和恢复的重要性。
IV级，治疗性研究。
