All-Epiphyseal Anterior Cruciate Ligament Repair Using Suture Ring Device in the Skeletally Immature Patient.

Anterior cruciate ligament (ACL) tears in pediatric patients pose distinct challenges in management, especially in patients with open distal femoral and proximal tibial physes. There are a variety of contemporary reconstruction techniques that attempt to address these challenges. However, with the resurgence of ACL repair in the adult population, it has become apparent that the pediatric patient may also benefit from primary ACL repair rather than reconstruction. ACL repair is a procedure performed to treat ACL tears that avoids the donor-site morbidity seen with ACL reconstruction using autograft. We describe a surgical technique involving FiberRing sutures (Arthrex, Naples, FL) and TightRope-internal brace fixation (Arthrex) for ACL repair with all-epiphyseal fixation in the pediatric patient. The FiberRing is a knotless, tensionable suture device that can be used to stitch the torn ACL and coupled with the TightRope and internal brace to fix the ACL.

Removal of Ioban May Pull Bacteria to the Surface of the Skin: Lessons Learned.

CONTEXT: Cutibacterium acnes (C. Acnes, formerly known as Propionibacterium acnes) are slow growing, gram positive, anaerobic bacilli. C. acnes are found in many locations, both as part of normal skin flora, as well as a contaminant of environmental surfaces. These bacteria have been associated with prosthetic joint infections of the shoulder, and it has been challenging to prevent such infections for a variety of reasons. The purpose of this quality improvement project was to investigate whether the surgical adhesive dressing Ioban could pull subcutaneous C. acnes bacteria from the surgical field. METHODS: During this quality improvement project, a convenience sample of 16 adult volunteers were gathered from other residency departments and from medical students at our hospital. The volunteers were used to take samples from two sites on each shoulder. The shoulder sites were prepped and covered with iodine-impregnated dressings. RESULTS: There were 26 of 64 (40.6%) samples in the no Ioban group that grew C. acnes. The Ioban group had 37 of 64 (57.8%) samples found to be positive for C. acnes growth. During this project, we identified several key points that could be useful to future researchers working in community hospitals. We describe these lessons concerning ongoing communication with lab and research departments, offering volunteers compensation to participate, interacting with departments unaccustomed to research, and development of a clear methodology. CONCLUSIONS: This was the first time our department had conduct a project utilizing the laboratory as well as volunteers. This came with unforeseen challenges which caused significant time delays. We believe that by highlighting these lessons for future researchers, they might avoid such problems during project activities.