Comparison of Complications in X-Ray Versus Ultrasound-Guided Hip Arthroscopy.

PURPOSE: To report the complication rates and frequency of iatrogenic injury to the cartilage and labrum when using an ultrasound-guided hip arthroscopic technique compared with the standard x-ray-guided technique. METHODS: In this retrospective cohort study of prospectively collected data, intraoperative videos were evaluated for iatrogenic injury during portal establishment. Postoperative complications and revision procedures were monitored for 12 months. RESULTS: The study included 460 patients, with 38% in the ultrasound cohort. Video review showed a 2% complication rate of femoral head scuffing and <2% labral injury in both techniques, with no significant difference between techniques in cartilage injury (P = .90) or labrum puncture (P = .41). Six patients underwent revision procedures, 2 in the x-ray group and 6 in the ultrasound group. One patient developed a deep infection postoperatively. There were no other major complications. CONCLUSION: Ultrasound-guided hip arthroscopy is a safe alternative to the standard x-ray-guided procedure in patients with a BMI less than 35. LEVEL OF EVIDENCE: III, retrospective cohort.

Mixed-Methods Analysis of a Validated Arthroscopic Knot-Tying Simulator With New Indirect Visualization Condition.

BACKGROUND: Simulation provides low-risk opportunities for surgical trainees to learn and practice fundamental skills. One simulation tool for orthopaedics is the Arthroscopic Knot (ArK) Trainer, which has been validated as an effective simulation tool across multiple methodologies. Previous studies have investigated the ArK Trainer in its basic form using clear plexiglass, which allows direct visualization of tissue anchors. PURPOSE: Using a mixed-methods approach, we assessed and compared junior and senior trainees' Seoul Medical Center (SMC) knot-tying performance under direct and indirect visualization. STUDY DESIGN: Cross-sectional study. METHODS: Fourteen orthopaedic surgery postgraduate trainees at a single medical school were recruited to participate. Trainees tied SMC knots using the Ark Trainer under direct and indirect visualization. A mixed-methods approach was used to evaluate knot-tying proficiency and characterize participants' approach to knot-tying. Knot-tying proficiency was evaluated using validated tools: a task-specific checklist (TSC), a global rating scale (GRS), and a proficiency scale (PS). Participants' approach to knot-tying was characterized using Likert-type questionnaires and semistructured interviews. An α level of .10 was set a priori owing to the small pool of trainees. RESULTS: The 14 participants included 7 junior residents (postgraduate years [PGYs] 1 and 2) and 7 senior residents (PGY ≥3), of whom 3 were fellows (PGY 6). Senior trainees outperformed junior trainees on both versions of the ArK Trainer: clear (GRS, P = .055; PS, P = .075) and covered (TSC, P = .05). Overall, participants performed better under direct visualization conditions (GRS, P = .05). In semistructured interviews, significantly more senior trainees discussed relying on haptic cues while tying knots under direct visualization (P = .021). The majority of trainees agreed that both versions of the ArK Trainer were realistic and appropriate practice formats for their level of training. CONCLUSION: Senior trainees were significantly more experienced than were junior trainees in arthroscopic skill and outperformed them on both configurations: direct (PS and GRS) and indirect (TSC) visualization. Experienced trainees were significantly more likely to report using tactile cues to aid knot-tying under indirect visualization. It is likely that inexperienced trainees rely more heavily on direct visualization and that the use of tactile cues may be an indicator of knot-tying proficiency. Trainees recommended progression from direct to indirect visualization configurations for inexperienced learners.

Posterior Glenohumeral Capsular Reconstruction Using an Acellular Dermal Allograft.

Posterior shoulder instability is an uncommon and challenging cause of shoulder pain and dysfunction. Surgical management has less reliable results and higher failure rates compared with techniques for anterior shoulder instability. The presence of generalized ligamentous laxity further complicates options for surgical management. If primary capsulolabral repair fails, controversy exists as to the optimal revision procedure. This technical description and video present an arthroscopic technique for reconstruction of the posterior glenohumeral capsule with an acellular dermal allograft to treat posterior instability in a patient with Ehlers-Danlos syndrome and a previously failed posterior capsular plication.

Editorial Commentary: Using Bankart "Plus" Techniques to Tackle Anterior Shoulder Instability With Bone Loss: Can Newer Arthroscopic Adjuncts Provide Long-Term Stability?

The debate between arthroscopic Bankart repair versus the Latarjet technique for patients with anterior shoulder instability largely hinges on the argument between redislocation rate versus complication rate. This difference becomes more apparent when considering patients with bone loss. We believe that Bankart "plus" techniques, including arthroscopic anatomic bone grafting, create a stable shoulder with a low instability recurrence rate, while maintaining a complication rate comparable to the Bankart repair.

Synthesis and biological activities of 4-N-(anilinyl-n-[oxazolyl])-7-chloroquinolines (n=3' or 4') against Plasmodium falciparum in in vitro models.

The synthesis (Pd-mediated coupling strategy) and characterization (NMR, IR, elemental analysis, etc.) of a short series of quinoline-oxazole hybrid compounds has been carried out. These materials are found to be moderately active against Plasmodium falciparum in vitro, with activities in the sub-micromolar range, and to display acceptable cytotoxicity to mononuclear leukocytes. Chemical modification strategies, with the intention to increase the biological potency of this new class of anti-malarial agents, are discussed.