Purpose Poor balance in anterior cruciate ligament reconstruction (ACLR) patients indicates neuromuscular control (NMC) deficits, which may be associated with altered cortical activation in the brain. This study examines cortical activation patterns in ACLR patients compared with healthy controls during a single‐leg balance task with and without visual feedback. Methods Thirteen ACLR patients (ACLR, 23.38 ± 3.38 years) and thirteen healthy controls (CONT, 23.54 ± 3.48 years) performed a single‐leg balance task with both visual feedback (VF) and non‐visual feedback (NVF) with continuous electroencephalograph (EEG) monitoring. Knee function was also evaluated through a subjective assessment survey. Results Frontal theta power was significantly higher with VF compared to NVF. Significant group‐by‐condition interaction effect for parietal alpha‐2 revealed that the CONT group had increased activation with VF, whereas the ACLR group had increased activation with NVF. A negative correlation emerged between KOS‐ADL in the ACLR group with parietal alpha‐2 during NVF and occipital alpha‐2 during VF. Conclusion ACLR patients had comparable single‐leg balance to healthy controls, yet different cortical activation patterns emerged on EEG. ACLR patients with better knee function showed greater cortical activation in the somatosensory and visual cortices. Further research should consider these cortical changes in restoration of balance after ACLR.

We present a case of a rare metastatic bone lesion of the acetabulum, associated with a pathologic fracture, found to be metastasis from a malignant carotid body paraganglioma upon histological analysis. We present a report of the patient's clinical course following the identification of metastatic disease to the right acetabulum, as well as a review of paragangliomas and their propensity for metastasis.

Introduction: a primary goal in revision total knee arthroplasty is to recreate and restore near-normal knee biomechanics by reapproximating the native anatomy. Tibial bone loss poses a challenge for surgeons. Bone cement, bone allograft, screws-in-cement, metaphyseal sleeves or cones, and metallic augments are some options for addressing bony deficiency, with endoprosthetic proximal tibia replacement a consideration for the most severe cases. Case Description: we present a case for the novel use of threaded Steinmann pins augmented with cement to reconstruct a massive tibial metaphyseal cortical defect during revision knee arthroplasty. A 76-year-old male presented with an infected primary total knee arthroplasty using MSIS (Musculoskeletal Infection Society) criteria and underwent a standard two-stage revision total knee arthroplasty once the knee was confirmed sterile. Intraoperatively, significant posteromedial and metaphyseal tibial bone loss was identified. In order to avoid proximal tibial replacement and the extensor mechanism complications seen with these, coupled with obligate gastrocnemius flap, a metaphyseal cone was utilized in the proximal tibia with four vertical threaded Steinmann pins spaced approximately 1 cm apart at its periphery, subsequently cut flush with the level of the cone after cementation to recreate the tibial cortex. The patient’s function and range of motion continue to improve with no evidence of structural complication at 2.5 years of follow-up. Discussion: the implementation of threaded Steinmann pins was utilized in this case to stabilize a cemented metaphyseal cone in the revision of an infected total knee with significant tibial bone loss. The threaded property may help prevent migration of these pins in comparison to smooth pins. Creation of a stable platform in a revision total knee arthroplasty poses a substantial challenge in the context of significant bone loss, and our case depicts a good short-term outcome and another option for surgeons to consider before moving toward endoprostheses.

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In this study, we aimed to compare the effectiveness of one dose of tranexamic acid (TXA) at the time of hospital admission versus two doses of TXA (one at the time of hospital admission and another dose intraoperatively) in reducing perioperative total blood loss in patients with extracapsular hip fractures. MethodsThis retrospective cohort study included 80 patients from a single institution who underwent surgical fixation for extracapsular hip fractures. Forty patients received a single dose of 1 gram of TXA at the time of hospital admission (per standardized protocol of an ongoing research study at the time), and 40 patients received the same dose of TXA on hospital admission as well as a second dose of 1 gram of TXA intraoperatively at the time of incision (per standard practice change following the completion of the research study). The primary study outcome of interest was total blood loss, which was calculated by estimating blood volume via Nadler's formula followed by calculating the total blood loss with the hemoglobin dilution method. Secondary outcomes included blood transfusion rates, hospital length of stay (LOS), and 30-day mortality. ResultsPatient gender, age, the American Society of Anesthesiologists (ASA) score, procedure length, fracture type, hardware type, and hemoglobin on hospital arrival were similar across the study groups (all p>0.05), though the twice-dosed group had a higher average BMI (26.4 kg/m 2 vs. 24 kg/m 2 , p=0.04). When adjusting for BMI, the twice-dosed group was estimated to have a slightly larger but non-significant difference in total blood loss (115-ml difference, 95% CI: 158.2-389.3, p=0.40) compared to the single-dose TXA group. More patients in the twice-dosed group required blood transfusion compared to the single-dose TXA group, though this was not statistically significant (30.0% vs. 17.5%, adjusted OR=1.64, 95% CI: 0.55-5.12, p=0.38). The distribution of hospital LOS and 30-day mortality rates were similar across the groups (p=0.13 and p>0.99). ConclusionIn the setting of surgically treated extracapsular hip fractures, patients who received one dose of TXA at the time of hospital admission and a second intraoperative dose of TXA did not demonstrate significant differences in total blood loss or a need for blood transfusion compared to patients who only received a single dose of TXA at the time of hospital admission.