No increased complication rate with the use of soft tissue quadriceps tendon autograft for primary ACL reconstruction - a systematic review.

BACKGROUND: The autograft of choice for anterior cruciate ligament reconstruction (ACLR) remains debateable. Recently there has been increased popularity of soft tissue quadriceps tendon (s-QT) autograft due to less donor site morbidity, reduced anterior knee pain and comparable re-operation and complication rates. The aim of this review was to analyse functional outcomes of primary ACLR using s-QT in adult population without the bone plug and to report its complication profile against other autografts. PATIENT AND METHODS: This systematic review was performed in accordance with PRISMA guidelines and a review of literature was conducted on four online databases (Medline, EMBASE, Cochrane and Google Scholar). Clinical studies reporting on patients undergoing primary ACLR with s-QT autograft or in comparison to BPTB or HS autografts with a minimum of 6 months follow-up were included. The studies were inclusive of only all soft tissue QT autograft regardless of the implants or fixation method used. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool. RESULTS: Fourteen studies were eligible. There were three randomised control studies (RCT) and 11 non-randomised comparative studies with 1543 patients who underwent ACLR. 682 underwent s-QT, 498 had hamstring tendon (HT) and 174 had bone-patellar tendon-bone (BPTB). 60% (n = 930) were males and mean follow up was 23.6 months (6-65). Eight studies reported post-operative patient reported outcome measures (PROMs). The mean International Knee Documentation Committee (IKDC) score was 91.5 ± 15.1 whereas mean Lysholm score was 90 ± 3.9. Five studies reported on laxity with mean anterior tibial translation (ATT) of 1.28 ± 1.09 mm. Overall complication rate of s-QT ACLR was 6% with 3% graft failure, 0.52% arthrofibrosis, 0.2% infection, 0.75% revision ACLR. There was no significant difference in functional outcome scores, knee stability and range of motion (ROM) between s-QT, HT and BPTB. CONCLUSION: s-QT for ACLR has a comparable functional outcome, laxity, failure and with overall graft failure rate of 3%. LEVEL OF EVIDENCE: III; Systematic review and meta-analysis.

Common Peroneal Nerve Compression Neuropathy Due to a Large Synovial Cyst From the Proximal Tibiofibular Joint in a Teenager.

Ganglion cysts are very rare in the lower limb and when present, ganglion cysts rarely cause compression neuropathy at any site. Peripheral nerve sheath tumors as a whole, are also very rare and mostly presented as a painful lump along the nerve path. Ganglion cysts are non-neoplastic gelatinous cysts, which lack true synovial lining. They can be divided into intraneural cysts which can be found within the epineurium of a peripheral nerve and lead to signs and symptoms of peripheral neuropathy or extraneural cysts which can develop from surrounding joints or tendon sheaths causing gradual nerve compression. Intraneural tumors of common peroneal nerve (CPN) are widely reported in the literature with varying degrees of symptoms; however, there are only a few case reports describing CPN palsy due to extraneural cysts. We are reporting a rare case of atraumatic CPN palsy, which resulted in irreversible foot drop in a teenage boy who presented with right leg radiating calf and foot pain. We recommend prompt investigation and excision of the cyst to decompress the nerve to increase the chances of early recovery and favorable outcomes.

Anterior Approach for Fixation of Acetabular Fractures Using Anatomically Designed Plates: Accuracy of Reduction and Early Functional Outcomes With a Minimum of 1-Year Follow-Up.

OBJECTIVES: To evaluate the results of a new plate system using anterior approaches in the management of acetabular fractures. DESIGN: Retrospective case-note review. SETTING: Pelvic and acetabular tertiary center. PATIENTS AND INTERVENTION: A consecutive series of acetabular fractures treated using only anterior approach and anatomical plates, at one tertiary specialist unit, were reviewed. The fracture patterns, incisions used, intraoperative and postoperative complications, reduction achieved (measured on postoperative radiographs and computed tomography scans), and early postoperative results (minimum 1-year follow-up) were recorded. MAIN OUTCOME MEASUREMENT: Postoperative reduction (measured by postoperative plain radiographs and computed tomography). RESULTS: Thirty-three patients (mean age, 57 years) underwent reconstruction with the anatomical plates using anterior approaches. Associated both columns and anterior column posterior hemitransverse represented most of the patients (85%). The fracture pattern was complex with quadrilateral plate involvement in 79% of cases. Overall, anatomic reduction was seen in 82% on plain radiographs and CT scan evaluation. Increasing age was a statistically significant variable in obtaining anatomical reduction with an age cutoff value of 70 years ( P 0.012). Associated both column fractures were associated with a lower incidence of anatomical reduction ( P = 0.038). Complication rates were comparable with the literature. 22 patients (71%) were symptom free, with 20 patients (62.5%) having excellent radiographic outcomes at the latest follow-up. CONCLUSIONS: The results suggested that using approach-specific instruments and anatomical plates through anterior approaches in a specialized unit led to anatomical reconstruction in 82% with patients demonstrating satisfactory early radiological and functional outcomes at 1 year. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The use of tissue adhesive as an adjunct to wound closure in knee arthroplasty does not reduce wound ooze.

INTRODUCTION: Persistent wound ooze has been associated with prolonged length of hospital stay and increased risk of infection. Recently, the use of tissue adhesive after hip and knee arthroplasty has been described. We believe that knee arthroplasty wounds exhibit different behavior compared to hip arthroplasty due to the increased wound-margin tension associated with knee flexion. PATIENTS AND METHODS: Forty-three patients undergoing total knee arthroplasty (TKA) by a single surgeon were studied. All wounds were closed using staples with or without tissue adhesive. Post-operatively, the wounds were reviewed daily for ooze. Dressings were changed only if soaked > 50% or if there was persistent wound discharge of more than 2 × 2 cm at 72 h. RESULTS: There were 21 patients in the tissue adhesive (group 1), 22 in the non-tissue adhesive (group 2) with the average age for group 1 of 72.2 years and for group 2 of 69.3 years. The median length of stay for both groups was 4 days (range of 3-7 days for group 1 and 2-6 days for group 2) (P = 0.960). The tissue adhesive group showed a statistically significant reduction in wound ooze on day 1 (P = 0.019); however, the difference was not significant on the following days. The median for the number of dressing changes for group 1 was zero changes and for group 2, one change. This was not statistically significant (P = 0.112). No complications were observed in both groups and there were no reactions to the tissue adhesive. CONCLUSION: The data from this case series suggest that the use of tissue adhesive may reduce wound ooze on day 1 only. The latter is most likely due to significant tensile forces to which the knee arthroplasty wound is subjected in the immediate post-operative rehabilitation. Further, the cost of tissue adhesive is not offset by reduced dressing changes or length of hospital stay.