Cancio-Bello, Alexandra M

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.

OBJECTIVES: To evaluate tranexamic acid (TXA) when administered immediately on hospital presentation in patients with extracapsular peritrochanteric hip fractures to determine its effect on (1) transfusion rates, (2) estimated blood loss, and (3) complications. METHODS: Design: Prospective, double-blinded, randomized clinical trial. Setting: Single-center, Level 1 trauma center. Patient Selection Criteria: All patients with isolated OTA/AO 31-A fracture patterns from 2018 to 2022 were eligible for inclusion. Study drug was administered in the emergency department at the time of presentation—1-g bolus over 10 minutes followed by a 1-g infusion over 8 hours. Outcome Measures and Comparisons: The primary outcome was the rate of red blood cell transfusion hospital days 1–4. Secondary outcomes included estimated blood loss and complications including venous thromboembolic events, stroke, myocardial infarction, all-cause 90-day readmissions, and all-cause mortality. RESULTS: One hundred twenty-eight patients were included—64 patients were randomized to intravenous TXA and 64 patients to intravenous normal saline (ie, placebo). There was no difference in the rate of red blood cell transfusion between treatment arms between hospital days 1–4 (27% in the TXA arm vs. 31% in the placebo arm, P = 0.65). Patients randomized to placebo who required transfusion received a mean of 2.30 units compared with 1.94 units in the TXA cohort (P = 0.55). There was no difference in the estimated blood loss between hospital days 1–4. There was no difference in the incidence of postoperative complications including venous thromboembolic events, stroke, myocardial infarction, 90-day readmission, or death. CONCLUSIONS: The results of this study do not support the use of preoperative TXA for reducing blood loss for geriatric patients with extracapsular hip fractures. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Objectives: To investigate the correlation between a screw's radiographic relationship to the piriformis fossa with position on CT in the clinical setting. Methods: Intraoperative fluoroscopic images of patients treated with cannulated screw fixation of a femoral neck fracture, who also had a postoperative CT scan, were retrospectively evaluated by 4 fellowship-trained orthopaedic trauma surgeons. The posterosuperior screw on the AP fluoroscopic view was determined to be above the piriformis fossa (APF) or below the piriformis fossa (BPF). Using CT scan to determine IOI placement, the ability to predict IOI position based on fluoroscopic imaging was evaluated by calculating accuracy, sensitivity, specificity, and interobserver reliability. Results: 73 patients met inclusion criteria. The incidence of IOI screw placement was 59% on CT evaluation. The use of the PF landmark accurately predicted CT findings in 89% of patients. A screw placed APF was 90% sensitive and 88% specific in predicting cortical breach, with near-perfect interobserver agreement (κ = 0.81). Conclusion: The use of the PF radiographic landmark is highly sensitive and specific in predicting the placement of an IOI posterosuperior femoral neck screw. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.