Purpose (1) To compare the incidence of post‐operative septic arthritis following anterior cruciate ligament reconstruction (ACLR) between patients receiving routine pre‐operative intravenous (IV) prophylaxis only intravenous (IV) infection prophylaxis and patients receiving additional graft‐soaking in a vancomycin solution (5 mg/ml) perioperatively. (2) To review the literature regarding effects of graft‐soaking in vancomycin solutions on outcomes, complication rates and tendon properties in ACLR. Methods To identify studies pertaining to routine pre‐operative IV prophylaxis and additional usage of intra‐operative vancomycin‐soaked grafts in primary ACLR, the Cochrane Library, SCOPUS and MEDLINE were searched till June 2018 for English and German language studies of all levels of evidence following the PRISMA guidelines. Additionally, all accepted abstracts at the ESSKA 2018, ISAKOS 2017, AGA 2017 and AOSSM 2017 meetings were screened. Data regarding the incidence of septic arthritis were abstracted and combined in a meta‐analysis. Data including outcome scores, complication rates and in vitro analyses of tendon properties were collected and summarized descriptively. Results Upon screening 785 titles, 8 studies were included. These studies examined 5,075 patients following ACLR and followed from 6 to 52 weeks post‐operatively. Of those 2099 patients in the routine pre‐operative IV prophylaxis group, 44 (2.1%) cases of early septic arthritis were reported. In contrast, there were no reports of septic arthritis following ACLR in 2976 cases of vancomycin‐soaked grafts. The meta‐analysis yielded an odds ratio of 0.04 (0.01–0.16) favouring the addition of intra‐operative vancomycin‐soaking of grafts. Across all available studies, no differences in clinical outcome (i.e. incidence of ACL revision, IKDC score, Tegner score), biomechanical tendon properties, or cartilage integrity between patients with and without vancomycin‐soaked grafts were identified. Conclusion The incidence of septic arthritis following ACLR can be reduced dramatically by vancomycin‐soaking the grafts intra‐operatively prior to graft passage and fixation. Within the limitation confines of this study, intra‐operative graft‐soaking in vancomycin appears to be a safe and effective method to reduce the incidence of septic arthritis following ACLR. Still, it remains debatable if the available data facilitate the recommendation for a universal application of vancomycin‐soaking for all ACLR patients or if it should be reserved for patients at risk, including the use hamstring tendons, revision cases and in the presence of medical preconditions. Level of evidence Level IV, systematic review of Level III and Level IV studies.

Case series, Level IV.

Wound healing is a complex biological process that requires a well-orchestrated interaction of mediators as well as resident and infiltrating cells. In this context, mesenchymal stem cells play a crucial role as they are attracted to the wound site and influence tissue regeneration by various mechanisms. In chronic wounds, these processes are disturbed. In a comparative approach, adipose-derived stem cells (ASC) were treated with acute and chronic wound fluids (AWF and CWF, respectively). Proliferation and migration were investigated using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test and transwell migration assay. Gene expression changes were analysed using quantitative real time-polymerase chain reaction. AWF had a significantly stronger chemotactic impact on ASC than CWF (77·5% versus 59·8% migrated cells). While proliferation was stimulated by AWF up to 136·3%, CWF had a negative effect on proliferation over time (80·3%). Expression of b-FGF, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 was strongly induced by CWF compared with a mild induction by AWF. These results give an insight into impaired ASC function in chronic wounds. The detected effect of CWF on proliferation and migration of ASC might be one reason for an insufficient healing process in chronic wounds.

BackgroundMultiple organ dysfunction and multiple organ failure (MOF) is still a major complication and challenge in the treatment of severely injured patients. The incidence varies decisively in current studies, which complicates the comparability regarding risk factors, treatment recommendations and patients’ outcome. Therefore, we analysed how the currently used scoring systems, the MODS, Denver- and SOFA Score, influence the definition and compared the scores’ predictive ability.MethodsOut of datasets of severely injured patients (ISS ≥ 16, Age ≥ 16) staying more tha 48 h on the ICU, the scores were calculated, respectively. The scores’ predictive ability on day three after trauma for resource requiring measurements and patient specific outcomes were compared using receiver-operating characteristics.ResultsOne hundred seventy-six patients with a mean ISS 28 ± 13 could be included. MODS and SOFA score defined the incidence of MOF consistently (46.5 % vs. 52.3 %), while the Denver score defined MOF in 22.2 %. The MODS outperformed Denver- and SOFA score in predicting mortality (area under the curve/AUC: 0.83 vs. 0.67 vs. 0.72), but was inferior predicting the length of stay (AUC 0.71 vs.0.80 vs.0.82) and a prolonged time on mechanical ventilation (AUC 0.75 vs. 0.81 vs. 0.84). MODS and SOFA score were comparably sensitive and the Denver score more specific in all analyses.ConclusionsAll three scores have a comparable ability to predict the outcome in trauma patients including patients with severe traumatic brain injury (TBI). Either score could be favored depending weather a higher sensitivity or specificity is targeted. The SOFA score showed the most balanced relation of sensitivity and specificity. The incidence of posttraumatic MOF relies decisively on the score applied. Therefore harmonizing the competing scores and definitions is desirable.

on behalf of the AGA Knee Patellofemoral Committee W ith 6 events per 100 000 population, patellar dislocation is a common knee injury in Germany (1). Even though a considerable number of reviews comparing surgical and conservative treatment have been published, the optimal treatment for primary patellar dislocation remains the subject of controversy. While sheared-off chondral or osteochondral fragments are either surgically reattached or, if too small, removed, no consensus has so far been reached on the best strategy of treatment in patients with no such concomitant injuries (2-6). Recurrent episodes of patellofemoral instability are associated with a high incidence of cartilage injury (70-86%) (7, 8), considerably limiting the ability of these typically young patients to engage in an active lifestyle (9). Consequently, the aim of any treatment approach should be to prevent redislocation in the long term. The