Despite its popularity, the direct anterior approach for hip arthroplasty is not without complications. Intraoperative femoral shaft perforation using this approach ranges from 0.8% to 7%. A missed perforation can lead to fracture with the need for further surgery if not detected intraoperatively. We describe a reproducible and cost-effective technique using a plastic Yankauer suction handle to help identify proximal femoral perforations during direct anterior total hip arthroplasty. Careful attention to the visual, tactile, and auditory feedback provided by the suction handle can help ensure the cortical continuity of the proximal femur. Familiarity with relevant surgical anatomy, improving surgical technique, and scrutinizing implant positioning helps minimize the risk of complications during the direct anterior approach.

The quad tendon has increasingly became a very common option for anterior cruciate ligament reconstruction. Minimally invasive approaches are one of the many advantages to the quad tendon graft. One of the issues with a small incision is assuring appropriate proximal closure. In this technique, we use the arthroscope to view proximally and a Scorpion (Arthrex) device to close our proximal quad harvest. We also describe the updated preparation of the quad tendon with FiberTag TightRope (Arthrex) and FiberTag ABS (Arthrex). These implants have FiberTag incorporated to the suspensory devices that creates a stable construct that is faster to incorporate into the quad with the slotted clamp. Together, these updates to the preparation and harvest should make the construct more reproducible and decrease donorsite morbidity respectively.

Osteochondral defects in the young active patient remain a difficult issue to treat. Autograft cartilage implantation is a procedure that was originally devised as a difficult 2-stage process, with disadvantages including donor-site morbidity and the need for multiple procedures. Recently, a technique for a single stage autograft cartilage transfer, also known as AutoCart using the GraftNet device for autograft harvest and BioCartilage in addition to bone marrow concentrate to aid in graft incorporation and healing, has been described. In this article, we discuss a modification of this autograft cartilage transfer procedure using a minimally invasive single incision for lesion preparation, microfracture, graft harvest, and graft delivery using visualization from the NanoScope.

Purpose: To examine the early clinical outcomes as well as safety of the Fertilized anterior cruciate ligament (ACL) reconstruction procedure. Methods: A total of 16 consecutive patients with a mean age of 24 years (range, 16-45 years), who had been treated with the fertilized ACL were evaluated and followed over 2 years. Four patients underwent reconstruction using an FGL GRAFTLINK allograft (LifeNet Virginia Beach, VA) and 12 using quadriceps autografts. All patients received the fertilized ACL as previously described using bone marrow composite, demineralized bone matrix, and an internal brace (Arthrex, Largo, FL). Clinical outcomes at 2 years including International Knee Documentation Committee and Marx scores were evaluated. Complication rates, including return to operating room, arthrofibrosis, infection, and rerupture rates, were also assessed. Results: All patients were followed for 6 months and all were released to full activity. In total, 11 of 16 patients were available for 2-year follow-up after the fertilized ACL reconstruction. At 2 years, the average International Knee Documentation Committee and Marx scores were 81 (standard deviation, 5.9) and 9 (standard deviation, 5.7), respectively. One patient required a return trip to the operating room for manipulation under anesthesia. No reruptures were observed at the 2-year mark. Nine of 11 patients had returned to their preinjury activity status at 2 years. Conclusions: The fertilized ACL, which adds biology and an internal brace to an ACL reconstruction, is a reliable and safe option when performing an ACL reconstruction. Very low complication risks were seen in this consecutive series followed for 2 years. Patients consistently returned to their preinjury activity status. Level of Evidence: Level IV, therapeutic case series.

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