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There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction : a nation-wide survey of ACL surgeons in Sweden

Ekdahl, Victor ; Stålman, Anders ; Forssblad, Magnus ; Samuelsson, Kristian ; Edman, Gunnar and Kraus Schmitz, Jesper LU orcid (2020) In Knee Surgery, Sports Traumatology, Arthroscopy 28. p.2535-2542
Abstract

Purpose: The use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons’ individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed. Methods: Questionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use... (More)

Purpose: The use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons’ individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed. Methods: Questionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use of a tourniquet during surgery. The responses were assessed for agreement and the thromboprophylaxis data were analysed in relation to the 2016 SKLR data. Results: 115 (75%) ACL surgeons responded to the survey. 81.7% prescribed thromboprophylaxis only when risk factors, such as history of thrombosis and the use of oral contraceptives, were present. Female gender, older age and admitted patient were considered the risk factors with the lowest impact. The respondents were generally restrictive regarding the use of prolonged antibiotic prophylaxis. The use of vancomycin-soaked graft was used by only nine (8%) surgeons representing 406 (13%) of the surgeries. Conclusion: Swedish ACL surgeons are generally restrictive using thromboprophylaxis and only when risk factors are present. However, there is a lack of consensus in how to weigh the different risk factors and it does not completely adhere to the existing literature. Prolonged antibiotic prophylaxis is rarely used and the use of vancomycin soaking of graft is very limited and applies only to a small number of surgeons. The use of tourniquet is common. There is a need for ACL-specific guidelines regarding the use of thromboprophylaxis. Level of evidence: IV.

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author
; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
keywords
ACL reconstruction, Antibiotic prophylaxis, Thromboprophylaxis
in
Knee Surgery, Sports Traumatology, Arthroscopy
volume
28
pages
2535 - 2542
publisher
Springer
external identifiers
  • pmid:32025765
  • scopus:85079461915
ISSN
0942-2056
DOI
10.1007/s00167-020-05851-7
language
English
LU publication?
no
additional info
Funding Information: Open access funding provided by Karolinska Institute. Publisher Copyright: © 2020, The Author(s).
id
1249891b-5467-40e7-a6b9-6dc981869f67
date added to LUP
2022-09-11 20:05:16
date last changed
2024-05-02 11:08:40
@article{1249891b-5467-40e7-a6b9-6dc981869f67,
  abstract     = {{<p>Purpose: The use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons’ individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed. Methods: Questionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use of a tourniquet during surgery. The responses were assessed for agreement and the thromboprophylaxis data were analysed in relation to the 2016 SKLR data. Results: 115 (75%) ACL surgeons responded to the survey. 81.7% prescribed thromboprophylaxis only when risk factors, such as history of thrombosis and the use of oral contraceptives, were present. Female gender, older age and admitted patient were considered the risk factors with the lowest impact. The respondents were generally restrictive regarding the use of prolonged antibiotic prophylaxis. The use of vancomycin-soaked graft was used by only nine (8%) surgeons representing 406 (13%) of the surgeries. Conclusion: Swedish ACL surgeons are generally restrictive using thromboprophylaxis and only when risk factors are present. However, there is a lack of consensus in how to weigh the different risk factors and it does not completely adhere to the existing literature. Prolonged antibiotic prophylaxis is rarely used and the use of vancomycin soaking of graft is very limited and applies only to a small number of surgeons. The use of tourniquet is common. There is a need for ACL-specific guidelines regarding the use of thromboprophylaxis. Level of evidence: IV.</p>}},
  author       = {{Ekdahl, Victor and Stålman, Anders and Forssblad, Magnus and Samuelsson, Kristian and Edman, Gunnar and Kraus Schmitz, Jesper}},
  issn         = {{0942-2056}},
  keywords     = {{ACL reconstruction; Antibiotic prophylaxis; Thromboprophylaxis}},
  language     = {{eng}},
  pages        = {{2535--2542}},
  publisher    = {{Springer}},
  series       = {{Knee Surgery, Sports Traumatology, Arthroscopy}},
  title        = {{There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction : a nation-wide survey of ACL surgeons in Sweden}},
  url          = {{http://dx.doi.org/10.1007/s00167-020-05851-7}},
  doi          = {{10.1007/s00167-020-05851-7}},
  volume       = {{28}},
  year         = {{2020}},
}