Adverse events and complications after primary ACL reconstruction with quadriceps tendon autograft: A systematic review

BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) surgery with quadriceps tendon (QT) grafts, both with and without a patellar bone plug, have gained popularity in recent years in the primary and revision settings. Postoperative complications occur with the use of QT autografts. PURPOSE: To systematically review the incidence of postoperative complications after primary ACLR QT autograft and compare complication rates in patients undergoing all-soft tissue QT grafts versus QT grafts with a patellar bone plug (QTPB). STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A literature search using the 2020 PRISMA guidelines was performed by querying PubMed, Embase, and Scopus databases from database inception through August 2022. Included were evidence level 1 to 4 human clinical studies in English that reported complications after primary ACLR with QT autograft. The incidence of complications within the included studies was extracted. Differences in the incidence of postoperative complications between ACLR with QT with and without a patellar bone plug were calculated. RESULTS: A total of 20 studies from 2004 to 2022, comprised of 2381 patients (2389 knees; 68.3% male) with a mean age of 27 years (range, 12-58 years), were identified. The mean follow-up was 28.5 months (range, 6-47 months). The total incidence of complications was 10.3%, with persistent postoperative knee pain being the most common (10.8%). Patients who underwent ACLR with all-soft tissue QT grafts had a 2.7-times increased incidence of anterior knee pain (23.3% vs 8.6%) and reoperations (5.9% vs 3.2%) when compared with QTPB grafts ( CONCLUSION: Complications after primary ACLR using QT autograft were recorded in 10.5% of knees, with anterior knee pain being the most common. No difference was reported in the overall incidence of complications with the use of the QT versus QTPB grafts; however, anterior knee pain was 2.7 times greater with use of a soft tissue quadriceps graft

Lateral versus crossed K wire fixation for Displaced Supracondylar Fracture Humerus in Children: Our Experience

Background: Lateral entry and crossed Kirschner (K) wire fixation configuration for treating  displaced suprcondylar humerus fracture in children has always been shrouded in controversy as to which is superior. As the closed K wire fixation is the standard of treatment for these fractures, we performed a prospective study comparing the two methods.Method: A prospective study comparing any reduction loss between the two groups was undertaken. Major end points documented were loss of fracture reduction and ulnar nerve injury, in addition clinical alignment, Flynn grade, range of motion, function, and complications. The operative procedure was standardized.Result: Sixty two patients were studied, 32 and 30 in cross K wire and lateral K wire entry group respectively. Two cases of iatrogenic ulnar nerve injury was documented in crossed K wire fixation group but it was insignificant (p value=0.336). No significant difference was observed in terms of change in Baumann or humerocapitellar angle, carrying angle, elbow range of movement.Conclusions : Both techniques are equally effective. Ulnar nerve injury can be minimized by taking certain precaution as in text