Evaluation of Autograft Contamination in Anterior Cruciate Ligament Reconstruction and Its Clinical Impact: A Systematic Review and Meta-Analysis.

Background: Understanding the characteristics of intraoperative graft contamination (IOGC) in anterior cruciate ligament reconstruction (ACLR) may guide infection control measures. Our aim was to determine the rate and characteristics of IOGC during ACLR and its clinical impact in relation to the development of postoperative infection.

Methods: A systematic review and meta-analysis using Cochrane methodology were performed. PubMed, Embase, CINAHL, and Cochrane CENTRAL were searched. Studies reporting on the rate of autograft contamination during ACLR were included. Meta-analysis was conducted using a fixed- or random-effects model as indicated. The study was prospectively registered with PROSPERO (CRD42024570199).

Results: Literature search identified 175 studies, of which 12 qualified for evaluation. Meta-analysis showed that the estimated rate of graft contamination during ACLR was 12.3% (confidence interval [CI] 7.8%-19%) when examining HT and BPTB grafts together. Similar rates were observed when examining HT and BPTB grafts in isolation (11.9%, CI 7.2-18.9, vs. 14%, CI 7.1%-25.6%). Meta-analysis of 2 studies that directly compared contamination between the graft preparation stage vs. harvesting stage showed a higher risk for the former, OR 3.23 (1.01-10.39, p = 0.049). Cultures were mostly monomicrobial, with Staphylococcus epidermidis being the most commonly isolated organism. There was no clear association between IOGC and postoperative clinically apparent infection, but the evidence assessing this parameter was sparse, and any link to chronic low-grade infection could not established.

Conclusion: There is a high rate of autograft contamination during ACLR, and elaborate infection prevention measures are required to reduce this.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.