Systematic Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2018; 9(11): 262-270
Published online Nov 18, 2018. doi: 10.5312/wjo.v9.i11.262
Should antibiotics be administered before arthroscopic knee surgery? A systematic review of the literature
John Carney, Nathanael Heckmann, Erik N Mayer, Ram K Alluri, Carleton Thomas Vangsness Jr., George F Hatch III, Alexander E Weber
John Carney, Nathanael Heckmann, Erik N Mayer, Ram K Alluri, Carleton Thomas Vangsness Jr., George F Hatch III, Alexander E Weber, Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA 90033, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 Statement have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Alexander E Weber, MD, Assistant Professor, Department of Orthopaedic Surgery, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033, United States.
Telephone: +1-818-9497381
Received: July 2, 2018
Peer-review started: July 2, 2018
First decision: July 18, 2018
Revised: September 9, 2018
Accepted: October 23, 2018
Article in press: October 23, 2018
Published online: November 18, 2018

To explore the current evidence surrounding the administration of prophylactic antibiotics for arthroscopic knee surgery.


Databases were searched from inception through May of 2018 for studies examining prophylactic antibiotic use and efficacy in knee arthroscopy. Studies with patient data were further assessed for types of arthroscopic procedures performed, number of patients in the study, use of antibiotics, and outcomes with the intention of performing a pooled analysis. Data pertaining to “deep tissue infection” or “septic arthritis” were included in our analysis. Reported data on superficial infection were not included in our data analysis. For the pooled analysis, a relative risk ratio was calculated and χ2 tests were used to assess for statistical significance between rates of infection amongst the various patient groups. Post hoc power analyses were performed to compute the statistical power obtained from our sample sizes. Number needed to treat analyses were performed for statistically significant differences by dividing 1 by the difference between the infection rates of the antibiotic and no antibiotic groups. An alpha value of 0.05 was used for our analysis. Study heterogeneity was assessed by Cochrane’s Q test as well as calculation of the I2 value.


A total of 49682 patients who underwent knee arthroscopy for a diverse set of procedures across 19 studies met inclusion critera for pooled analysis. For those not undergoing graft procedures, there were 27 cases of post-operative septic arthritis in 34487 patients (0.08%) who received prophylactic antibiotics and 16 cases in 10911 (0.15%) who received none [risk ratio (RR) = 0.53, 95% confidence interval (CI): 0.29-0.99, P = 0.05]. A sub-group analysis in which bony procedures were excluded was performed which found no significant difference in infection rates between patients that received prophylactic antibiotics and patients that did not (P > 0.05). All anterior cruciate ligament reconstruction studies used prophylactic antibiotics, but two studies investigating the effect of soaking the graft in vancomycin in addition to standard intravenous (IV) prophylaxis were combined for analysis. There were 19 cases in 1095 patients (1.74%) who received IV antibioitics alone and no infections in 2034 patients who received IV antibiotics and had a vancomycin soaked graft (RR = 0.01, 95%CI: 0.001-0.229, P < 0.01).


Prophylactic antibiotics are effective in preventing septic arthritis following simple knee arthroscopy. In procedures involving graft implantation, graft soaking reduces the rate of infection.

Keywords: Knee arthroscopy, Antibiotics, Systematic review, Vancomycin, Anterior cruciate ligament

Core tip: Our study is the first to demonstrate prophylactic antibiotics are effective in preventing septic arthritis following simple arthroscopic procedures of the knee, though given the large number needed to treat, the clinical significance of this finding is unclear. There is little to no debate that antibiotics should be used prophylactically for arthroscopic surgeries involving graft implantation. However, our findings indicate that the addition of graft soaking further reduces the rate of infection. Further study is warranted to identify patient populations and arthroscopic procedures in which the use of prophylactic antibiotics may not be necessary.