Open Bankart Revisited.

The surgical treatment of anterior shoulder instability can present a dilemma. Historically, an open Bankart repair was the benchmark solution. Over the last decade as surgeons became more arthroscopically savvy, the pendulum swung and a paradigm shift occurred. However, more recent studies have challenged this trend and, subsequently, revived interest in open repair. Thus, we feel it is critical to provide a more contemporary stepwise description of a procedure that has become essentially abandoned. The goal is to provide tips and pearls to achieve optimal exposure and, ultimately, a robust repair for a notoriously challenging operation.

A Validated Orthopaedic Surgical Simulation Model for Training and Evaluation of Basic Arthroscopic Skills.

BACKGROUND: To our knowledge, there is currently no validated educational model to evaluate and teach basic arthroscopic skills that is widely accessible to orthopaedic residency training programs. The primary objective was to design and to validate a surgical simulation model by demonstrating that subjects with increasing level of training perform better on basic arthroscopic simulation tasks. The secondary objective was to evaluate inter-rater and intra-rater reliability of the model. METHODS: Prospectively recruited participants were divided by level of training into four groups. Subjects performed six basic arthroscopic tasks using a box model: (1) probing, (2) grasping, (3) tissue resection, (4) shaving, (5) tissue liberation and suture-passing, and (6) knot-tying. A score was calculated according to time required to complete each task and deductions for technical errors. A priori total global score, of a possible 100 points, was calculated by averaging scores from all six tasks using equal weights. RESULTS: A total of forty-nine participants were recruited for this study. Participants were grouped by level of training: Group 1 (novice: fifteen medical students and interns), Group 2 (junior residents: twelve postgraduate year-2 or postgraduate year-3 residents), Group 3 (senior residents: sixteen postgraduate year-4 or postgraduate year-5 residents), and Group 4 (six arthroscopic surgeons). The mean total global score (and standard deviation) differed significantly between groups (p < 0.001): 29.0 ± 13.6 points for Group 1, 40.3 ± 12.1 points for Group 2, 57.6 ± 7.4 points for Group 3, and 72.4 ± 3.0 points for Group 4. Pairwise comparison with Tukey correction confirmed construct validity by showing significant improvement in overall performance by increasing level of training between all groups (p < 0.05). The model proved to be highly reliable with an intraclass correlation coefficient of 0.99 for both inter-rater and intra-rater reliability. CONCLUSIONS: A simulation model was successfully designed to teach and evaluate basic arthroscopic skills showing good construct validity. This arthroscopic simulation model is inexpensive, valid, and reliable and has the potential to be implemented in other training programs.

Ganglion cyst and olecranon physis nonunion in a baseball pitcher: unique treatment after conservative therapy fails.

Although ganglion cysts and stress fractures occur at many joints, the presence of both disorders at the same joint is rare. In this unusual case, a 30-year-old professional pitcher had been treated conservatively for presumed olecranon bursitis in his right (throwing) arm, but, when therapy failed, he sought additional care. A thorough workup and subsequent surgery revealed a ganglion cyst and nonunion of a stress fracture of the olecranon physis. The ganglion cyst had its origin at the fracture site, and both cyst and bone fragment were excised. The patient had a full recovery and was able to resume pitching as an instructor 18 months after surgery.