Less than 1% risk of donor-site quadriceps tendon rupture post-ACL reconstruction with quadriceps tendon autograft: a systematic review

PURPOSE

The purpose of this study is to develop a comprehensive complications profile for quadriceps tendon-autograft anterior cruciate ligament reconstruction (QT ACL-R).

METHODS

A traditional and grey literature search was conducted in accordance with PRISMA and R-AMSTAR guidelines. PubMed, EMBASE, MEDLINE, CINAHL, Cochrane, Web of Science, and many grey literature sources were searched from inception to May 29, 2022. All studies were searched and screened in duplicate with included studies being of all levels of evidence, reporting complications, and with patients of all ages undergoing primary ACL reconstruction with quadriceps tendon autograft in the last 15 years. Studies were excluded if they had cadaveric or animal subjects or were reviews. Risk of bias assessment was conducted using MINORS criteria for non-randomised studies and Cochrane's RoB 2.0 for randomised studies. Data were summarised with weighted event rates generated under a random-effects model.

RESULTS

A total of 55 studies (5315 reconstructions) were included: 32 used quadriceps tendon with bone block (B-QT), 19 used all-soft tissue quadriceps tendon (S-QT), and four did not report the QT graft subtype used. Included patients had an age range of 6.2-58 years and an average reported follow-up time of 28.1 months (range, 6-90 months) for non-randomised studies and 34.3 months (range, 0.233-120 months) for randomised studies. Pooled incidence rates for clinically relevant major complications included contralateral ACL injury at 6.0%, postoperative meniscal issues at 5.4%, cyclops lesions at 4.8%, graft failure at 4.1%, patellar fracture at 2.2%, hardware removal at 1.7%, infection at 1.5%, and donor-site quadriceps tendon rupture at 0.7%. Pooled incidence rates for clinically relevant minor complications included anterior knee pain at 9.7%, kneeling pain at 9.5%, sensation deficits at 4.4%, loss of extension at 4.2%, donor-site tendinopathy at 3.9%, cosmetic issues at 1.8%, and hematoma at 1.5%.

CONCLUSIONS

QT ACL-R resembles other graft types in its rates and types of postoperative complications. In this exploratory systematic review, no complications of QT ACL-R were found to be disproportionately represented in the literature. This graft type should remain an option with comparable complication rates to other graft choices.

LEVEL OF EVIDENCE

Level IV.

REGISTRATION

This study was preregistered under PROSPERO with preregistration code CRD42022302078.

Fetal movement, biochemical and biophysical parameters, and the outcome of pregnancy

Fetal movements, fetal heart rate patterns, and serum estriol levels were prospectively monitored in 91 high-risk and normal pregnant women. In four women, there was cessation of fetal movements. In three of these cases, there were pathologic changes in fetal heart rate patterns, with one neonatal death. Of the 87 women who did not demonstrate cessation of fetal movements, one had changes in fetal heart rate patterns. The difference between the two groups was statistically significant (Z test: p less than 0.001). No correlation was found between fetal movements and serum estriol levels in this study. Daily recording of fetal movements can be used as an effective screening test, with high sensitivity and specificity for the fetus in utero. Cessation of fetal movement places the fetus in a high-risk category and should alert the physician to the need for non-stress tests.

Application of a two-component LDV to the measurement of flows induced by flames propagating over condensed fuels

In the early stages of a fire, the two mechanisms by which heat transfer occurs are conduction and convection ahead of the flame through gas and fuel phases. The convective flows induced are characterized by low-fluid velocities with changes in magnitude and direction occurring over small distances accompanied by sharp temperature changes. These characteristics make quantitative measurements of fluid velocities difficult using conventional techniques. With the advent of LDV techniques, a nonperturbing means of making high resolution measurements of 2-D flows now exists. In this paper the details of the LDV facility and the results of some recent experiments on the flame spread problem are presented.