The peashooter device: an invaluable tool for bone grafting during revision anterior cruciate ligament surgery.

Anterior cruciate ligament (ACL) reconstruction is a commonly performed surgery. Despite the improved technique and understanding of the rehabilitation rationale, the long-term success rate of good or excellent results is 75% to 90%. That leaves 10% to 25% of reconstructed ACLs with unsatisfactory results. Certainly, revision ACL surgery is not required in every patient. It should be individualized according to symptoms, objective findings, and the expectations of the patients. Revision of a failed ACL reconstruction may be carried out either as a single-stage procedure or a staged procedure. A staged procedure is recommended in cases of tunnel enlargement and/or removal of the implants and the failed graft, which leaves large bone defects. Bone grafting of the tibial bone tunnel defect is usually not a problem. On the other hand, grafting the femoral bone tunnel defect can present a challenge. It is important to place enough bone graft into the femoral tunnel securely and tightly so that bone incorporation takes place before the second-stage surgery, when the new tunnel can be drilled and the new ligament graft placed. We describe a simple technique using the elasticity and transparent properties of a chest drain, which effectively delivers the bone graft to the femoral tunnel defect. We name it the "peashooter device."

Peroneal padding: an alternative to a peroneal post in hip arthroscopy.

Hip arthroscopy is commonly used both to diagnose and treat different underlying hip conditions. It may be performed either by a supine or lateral approach. A peroneal post is commonly used with a fracture table in both the supine and lateral positions to provide lateralization and traction of the femur. Adequate distraction of the hip joint may be difficult without the peroneal post. We achieved an effect similar to that of a peroneal post using a simple technique of peroneal padding. A long cushioning jelly bag is first wrapped around the peroneal post. It is then fixed by taping and further secured by bandaging. The patient is positioned so that the femur lies against this peroneal padding to provide optimal lateralization of the femur. Distraction of the hip joint is then performed by traction of the femur. We believe peroneal padding is a simple technique that allows adequate lateralization and good positioning of the femur.

Half-stained thread in shoulder arthroscopy: an improved method of suture management.

Shoulder arthroscopy is used widely to treat a variety of shoulder pathologies. These include various diagnostic and stabilization procedures such as Bankart repair, treating SLAP lesions, capsular plication, and rotator cuff repair. Sutures are commonly used, particularly in stabilization procedures, with or without the use of suture anchors. Suture management is one of the prerequisites for a successful arthroscopic stabilization procedure. We describe a simple method of aiding suture management. In cases using the suture anchor, the preloaded suture is firstly removed from the anchor, and approximately half the length of the suture is stained with methylene blue. The suture is then reinserted into the same suture anchor. The suture anchor is used in the usual manner. During shoulder arthroscopy, one end of the suture is pulled, if necessary, to determine the direction of the thread, which is readily shown by the methylene blue. This simple maneuver helps the surgeon identify the desired direction of the thread and avoid the common problems of pulling out the suture and twisting the sutures.