Abstract | 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: 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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Authors | Moin Khan, Benjamin B Rothrauff, Fahim Merali, Volker Musahl, Devin Peterson, Olufemi R Ayeni |
Journal | Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
(Arthroscopy)
Vol. 30
Issue 2
Pg. 236-44
(Feb 2014)
ISSN: 1526-3231 [Electronic] United States |
PMID | 24485117
(Publication Type: Journal Article, Review, Systematic Review)
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Copyright | Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Anterior Cruciate Ligament
(surgery)
- Anterior Cruciate Ligament Reconstruction
(methods)
- Anti-Bacterial Agents
- Equipment Contamination
(prevention & control)
- Humans
- Sterilization
(methods)
- Tendons
(microbiology, transplantation)
- Transplantation, Autologous
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