Purpose
This systematic review explores management strategies for intraoperative anterior
cruciate ligament (ACL) graft contamination.
Methods
Two databases (Medline and EMBASE) were screened for studies involving ACL graft contamination
published between 1946 and April 2013. We included studies evaluating the management
of a contaminated graft and excluded small case-series studies. We conducted a full-text
review of eligible studies, and the references were searched for additional eligible
studies. Inclusion and exclusion criteria were applied to the searched studies.
Results
Our search yielded 6 laboratory investigations with a total of 495 graft samples used.
These samples were contaminated and cleansed by various methods. The most successful
sterilization protocols used chlorhexidine or mechanical agitation with a polymyxin
B–bacitracin solution to achieve sterility in 100% of their respective experimental
graft tissues. A chlorhexidine soak and plain bacitracin soak were also effective,
at 97.5% and 97%, respectively. Povidone-iodine and an antibiotic soak of polymyxin-bacitracin
were the least effective, with sterility rates of 48% and 57%, respectively.
Conclusions
The results of this review suggest that the optimal agent for sterilizing a dropped
graft is chlorhexidine. A protocol of mechanical agitation and serial dilution with
a polymyxin B–bacitracin solution was also highly effective; however, the sample size
was too small to realistically recommend its use. Bacitracin alone was also found
to be an effective sterilization agent, as was a combined solution of neomycin and
polymyxin B. Pooled results showed that normal saline solution, povidone-iodine, and
a polymyxin B–bacitracin solution all yielded suboptimal sterilization. The available
evidence, however, is laboratory based and may not accurately reflect clinical conditions;
moreover, there is a lack of biomechanical studies evaluating sterilized grafts. As
a result, the findings should be interpreted with caution.
Level of Evidence
Level IV, systematic review of basic science studies.
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Article info
Publication history
Accepted:
October 29,
2013
Received:
September 27,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
