Koschmeder, Katelyn T.

Abstract Osteochondral lesions of the knee, particularly in patients with early osteoarthritic changes, remain a clinical challenge. The Agili‐C implant (CartiHeal, Smith & Nephew), an aragonite‐based osteochondral scaffold, offers a single‐stage, off‐the‐shelf solution designed to regenerate both cartilage and subchondral bone. Unlike cell‐based therapies, Agili‐C eliminates the need for cell harvesting, culturing, or bioreactors, and avoids the morbidity associated with autografts and allografts. Recent multicenter randomized controlled trials have showed superior functional outcomes and pain reduction with Agili‐C compared to microfracture and debridement, even in patients with early osteoarthritis (Kellgren‐Lawrence grades 0‐3). This Technical Note describes the surgical technique for Agili‐C implantation and highlights key technical pearls to optimize outcomes.

Purpose To project the future utilization of open and arthroscopic rotator cuff repair (RCR) in the Medicare population through 2050, incorporating post‐COVID recovery data to provide insight into evolving surgical preferences, economic pressures, and implications for health care delivery. Methods We analyzed 2003‐2024 data from the Centers for Medicare and Medicaid Services Medicare Part‐B National Summary, which captures all Medicare beneficiaries undergoing open or arthroscopic RCR as identified by Current Procedural Terminology codes. Projections were based on 2003‐2019 and 2023‐2024 data, reflecting post‐COVID‐19 recovery and avoiding distortions from 2020 to 2022 pandemic‐related disruptions. Statistical models evaluated included log‐linear, Poisson, negative binomial, and autoregressive integrated moving average. Autoregressive integrated moving average was selected based on the lowest normalized root mean square error, reflecting superior predictive accuracy and its ability to capture time‐dependent trends, and was used to forecast RCR volumes through 2050. Results In 2024, there were 23,154 open and 188,700 arthroscopic RCR procedures, which served as the baseline for modeling. Open RCR is projected to decline on average by 5.91% annually, while arthroscopic RCR is projected to grow by 2.88% annually. By 2050, arthroscopic RCR volume is expected to reach 394,434 procedures (95% forecast interval: 363,424‐425,321), whereas open RCR is expected to decline to 4748 procedures (95% forecast interval: 1243‐43,747). Conclusions Autoregressive integrated moving average modeling projects that by 2050 arthroscopic RCR utilization will increase by 2‐fold and open RCR will decline to one‐fifth compared with 2024 baseline volumes. Level of Evidence Level III, retrospective cohort study.

Purpose To determine if preoperative femoral or tibial bone marrow edema (BME) is indicative of higher rates of re‐tear and conversion to total knee arthroplasty (TKA) after posterior medial meniscal root tear repair, and, secondarily, whether preoperative BME impacted patient‐reported outcome measures and rates of infection and arthrofibrosis. Methods Patients that underwent posterior medial meniscal root tear repair between 2013 and 2021 with a 2‐year minimum follow‐up were retrospectively analyzed. Primary outcome measures included re‐tears and TKA conversion. Secondary outcomes included International Knee Documentation Committee (IKDC) score and Lysholm score, infection, and arthrofibrosis. Cohort‐specific minimally clinically important difference and Patient Acceptable Symptomatic Scale rates were calculated. Two‐tailed t‐tests, Wilcoxon rank‐sum tests, and Fisher's exact tests were used where appropriate. Results The study population consisted of 97 knees (74 without BME [NBME], 23 with BME) with average follow‐up of 38.9 months (24‐68). Preoperatively, the NBME group had higher IKDC scores ( P = .008). Postoperatively, the NBME group had higher IKDC scores at 6 months, 1 year, and 2 years (84.5 [6.0] vs 68.5 [11.0]) ( P = .041, <.001, <.001). IKDC minimally clinically important difference rates were not significantly different between groups at all follow‐ups. Patient Acceptable Symptomatic Scale rates were higher for the NBME group at 1‐year and final follow‐up (100.0% vs 60.9%) ( P < .001 for both). Lysholm scores were higher for the NBME group at 1‐year and final follow‐up (84.0 [5.6] vs 74.6 [12.8]) ( P = .019 and .008, respectively). Re‐tear occurred in 17.4% of the BME group and 0% of the NBME group ( P = .003). TKA conversion rates were 21.7% in the BME group and 2.7% in the NBME group ( P = .008). There was no difference in arthrofibrosis or infection rates. Conclusions Preoperative BME in patients undergoing posterior medial meniscal root tear repair is associated with higher rates of recurrent meniscal root tearing and conversion to TKA in addition to lower subjective IKDC and Lysholm scores compared to patients without preoperative BME. Level of Evidence Level III, retrospective prognostic case control series.

Background: Simultaneous carpal tunnel release (sCTR) with emergent forearm fasciotomy in the setting of acute compartment syndrome (ACS) has been reported, but the national incidence and cost of delayed carpal tunnel release (CTR) remain unknown. This large database study aims to evaluate how often sCTR is performed, the frequency of delayed CTR when not performed simultaneously, and the associated costs. Methods: The PearlDiver Mariner database was queried for patients who underwent forearm fasciotomies between January 1, 2015, and October 31, 2022. Patients were grouped based on CTR timing: simultaneous, within 2 weeks, 2 weeks to 1 year, 1 to 5 years, or no CTR. Reimbursement data were collected, and patient numbers and costs were analyzed across cohorts. Results: More than half of patients undergoing emergent forearm fasciotomy received sCTR. Among those who did not, 31% required CTR within 1 year and 35% within 5 years. The total cost was highest when CTR was performed within 1 year but not on the same day as fasciotomy. After 1 year, the additional cost of CTR was similar to that of patients who never underwent fasciotomy. Conclusions: This large database study shows that over one-third of patients who did not undergo sCTR at the time of emergent forearm fasciotomy required it within 1 year, incurring significantly higher costs. Including sCTR during initial fasciotomy may reduce delayed care and associated expenses. While these findings suggest that including sCTR during initial fasciotomy may reduce delayed care and expenses, the retrospective design precludes definitive recommendations, and clinical judgment remains essential Level of Evidence: 4