The impact of a meta-analysis on orthopaedic surgeons' practice with regards to vancomycin graft pre-soaking in anterior cruciate ligament reconstruction: a paper questionnaire survey study

Abstract

Background and Aims
Understanding the impact of orthopaedic scientific research is vital in identifying facilitators and barriers to its implementation in clinical practice. A meta-analysis was carried out which showed that presoaking hamstring (HT) autografts in vancomycin was associated with a 10-fold reduction in infection rate in anterior cruciate ligament (ACL) reconstruction. Our aim was to determine the practice of orthopaedic surgeons with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta-analysis.

Methods
A paper questionnaire survey was administered to attendees of an annual EFORT podium presentation of the meta-analysis findings. Descriptive statistics were used to summarize the characteristics of respondents and their responses.

Results
A total of 29 senior surgeons/subspecialists performing a median of 40 ACL reconstructions per year completed the survey of whom 7 (24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years. Only 3 (10.3%) presoaked the ACL graft with an antibiotic. About 1/4 of those who up to then did not pre-soak the graft (6/26, 23.1%) would consider changing their practice to pre-soaking with vancomycin, with similar findings (5/20, 25.0%) in those that used a HT autograft as their first choice.

Conclusions
Orthopaedic surgeons are receptive to the findings of a meta-analysis reporting on the effectiveness of vancomycin graft presoaking in ACL reconstruction, which can thus have a substantial impact upon clinical care. Addressing concerns about vancomycin induced graft toxicity and comparing the pre-soaking effect to that of specific intravenous antibiotic regimens may further enhance the uptake of this practice.