Modern ideas about the expediency of antibiotic prophylaxis in arthroscopic knee surgery: literature review

Despite advances in aseptic, antiseptic, and surgical techniques, the risk of infectious complications persists. Antibiotics have long been used to prevent these complications, particularly during surgeries involving prosthetic materials, implants, or transplants. However, their use prior to minimally invasive surgeries, such as knee arthroscopy, remains controversial. We reviewed international literature to summarize modern approaches to antibiotic prophylaxis in knee arthroscopy, as well as to determine the prospects of improving rational antibiotic prophylaxis regimens during these surgeries. The search was performed in PubMed/MedLine and eLIBRARY databases. The following search terms were used: “antibiotic prophylaxis in knee arthroscopy,” “antibiotic prophylaxis in ACL reconstruction,” “antibiotics in knee arthroscopy,” and “septic arthritis after knee arthroscopy.” The search yielded 567 studies published between 1986 and 2024. Following screening, 57 eligible studies were selected. All studies were conditionally divided into two groups. The first group included studies addressing routine arthroscopy without grafting. The second group included studies addressing infectious complications and antibiotic use during knee arthroscopy, using tendon allografts and autografts, with anterior cruciate ligament repair as an example. The literature review found that there is no consensus on the feasibility of antibiotic prophylaxis in routine knee arthroscopy. There were no significant differences in the incidence of deep infectious complications between groups of patients with and without preoperative antibiotic prophylaxis. During knee arthroscopy with the use of tendon grafts, antibiotic prophylaxis was performed in all identified studies. There are two commonly used regimens: a conventional regimen that exclusively uses intravenous antibiotics and a combination regimen that includes additional graft exposure to vancomycin solution. The incidence of deep infectious complications was considerably lower in the group where antibiotic prophylaxis was supplemented by graft exposure to vancomycin solution.