title: Graft salvage following infected anterior cruciate ligament reconstruction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To examine the rates of hamstring graft salvage with arthroscopic debridement of infected anterior cruciate ligament (ACL) reconstruction as reported in the literature and discuss functional outcomes.
  
  
  METHODS
  A search was performed without language restriction on PubMed, EMBASE, Ovid, CINAHL and Cochrane Register of Controlled Trials (CENTRAL) databases from their inception to April 2015. We identified 147 infected hamstring grafts across 16 included studies. Meta-analysis was performed using a random-effects model to estimate the overall graft salvage rate, incorporating two different definitions of graft salvage.
  
  
  RESULTS
  The graft salvage rate was 86% (95% confidence intervals (CI) 73% to 93%; heterogeneity: tau(2) = 1.047, I(2) = 40.51%, Q = 25.2, df = 15, p < 0.001), excluding ACL re-ruptures. Including re-ruptures as failures, the graft salvage rate was 85% (95% CI 76% to 91%; heterogeneity: tau(2) = 0.099, I(2) = 8.15%, Q = 14.15, df = 13, p = 0.36).
  
  
  CONCLUSIONS
  Arthroscopic debridement combined with antibiotic treatment can lead to successful eradication of infection and graft salvage, with satisfactory functional outcomes in many cases of septic arthritis following ACL reconstruction. Persistent infection despite repeat arthroscopic debridements requires graft removal with the intention of revision ACL surgery at a later stage.
  
  
  CONCLUSIONS
  Arthroscopic debridement combined with antibiotic therapy is an appropriate initial approach in most cases of septic arthritis following ACL reconstruction, achieving graft salvage rates of about 85%. Cite this article: Bone Joint J 2016;98-B:608-15.
authors.affiliation: Blackpool Victoria Hospital, 38 Whinney Heys Road Blackpool, Lancashire, FY3 8NR, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kuršumović
authors.affiliation: Blackpool Victoria Hospital, 38 Whinney Heys Road, Blackpool, FY3 8NR, and Honorary Professor, School of Medicine, University of Central Lancashire, Preston, PR1 2HE, Lancashire, UK.
authors.forename: C P
authors.initials: CP
authors.lastname: Charalambous
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001182:Arthroscopy; D003646:Debridement; D006801:Humans; D016879:Salvage Therapy; D013710:Tendons / Q000637:transplantation*
chemical_list: D000900:Anti-Bacterial Agents
keywords: ACL; Anterior cruciate; Infection; Septic