Military surgeons learn advanced arthroscopic shoulder techniques

Military surgeons must treat a variety of musculoskeletal conditions, with the goal of returning soldiers to active duty as soon as possible. Depending on their surgical training, some military surgeons may have had less exposure to some of the more advanced arthroscopic techniques currently being used.

A unique partnership between the Arthroscopy Association of North America (AANA) and the Society of Military Orthopaedic Surgeons (SOMOS) aims to ensure that military surgeons have the knowledge and skills necessary to provide the best possible care to active military personnel.

In mid October, 48 active military orthopaedic surgeons and a faculty of 24 AANA/SOMOS master surgeons converged on the Orthopaedic Learning Center (OLC) in Rosemont, Ill., for “Advanced Shoulder Arthroscopy,” a continuing medical education (CME) surgical skills course designed to enhance their understanding of the techniques needed to perform a variety of shoulder arthroscopic procedures.

“Most peacetime military surgical practice is sports-medicine related,” explained SOMOS President Lt. Col. John M. Tokish, MD, MC, USAF, who chaired the course, along with Richard K.N. Ryu, MD, and CDR Matthew T. Provencher, MD, MC, USN.

“Our entire medical military culture is designed around rapidly returning soldiers to full function and duty. Therefore, advanced arthroscopic techniques are extremely relevant for the military population,” Dr. Tokish added.

“AANA is committed to providing hands-on arthroscopic surgery education, and we were proud to lend our expertise to our colleagues in the Armed Forces,” said Dr. Ryu, AANA’s immediate past president.

“In the spirit of education and increasing collaboration among our societies, SOMOS and AANA believe strongly that we can and should learn from each other,” added Dr. Provencher. “We want to make sure we are providing the best possible care to our active duty personnel and their beneficiaries.”

AANA was able to create scholarships for the military participants through an unrestricted educational grant supported by Smith & Nephew and DePuy Mitek, Inc.

Focus on adult learning
The course’s faculty consisted of 24 master shoulder surgeons—12 from AANA and 12 from SOMOS.

“Bringing these two groups together encouraged adult learning that was very technique-focused,” said Dr. Provencher. “The format included debates, point-counterpoint discussions, case presentations, hands-on laboratory sessions, as well as some didactic lectures.”

“One of the goals of this course was to provide an intimate environment where the participants were matched closely with expert, master-level arthroscopic instructors,” Dr. Tokish added. “This allowed the education to go very deep in a short period of time.”

During the 2½ day course, participants learned to identify all intra-articular structures, pathology, anatomic variations, and indications for surgery. The skills section of the course enabled them to practice the surgical techniques needed to perform the following procedures:

• Arthroscopic removal of loose bodies, superior labral anterior-to-posterior (SLAP) tear repair, and knot tying techniques
• Arthroscopic shoulder stabilization procedures: anterior and posterior Bankart repair, capsular and rotator interval plication, and multidirectional instability (MDI) reconstruction
• Salvage techniques for osteoarthritis (OA) in the younger patient
• Arthroscopic rotator cuff repair: single row, double row, and margin convergence techniques
• Arthroscopic repair of partial rotator cuff tears: partial articular-sided supraspinatus tendon avulsions (PASTA) lesions
• Biceps evaluation, tenotomy, and tenodesis: soft-tissue, anchor, and interference screw techniques
• Intra- and extra-articular approaches to subscapularis repair
• Acromioclavicular joint repair and reconstruction

Given the outstanding faculty and curriculum, interest in the course was very high among military orthopaedic surgeons, so much so that a large number of them were placed on a waiting list.

“We hope to be able to fit more military surgeons into other OLC courses before the end of the year,” said Dr. Ryu. “We want to make sure that no military surgeon who wants to learn more about shoulder arthroscopy is denied that opportunity.”

Moving forward, AANA and SOMOS already have plans in place for a combined course that will focus on knee arthroscopy scheduled for Aug. 26–28, 2011.

“SOMOS would like to continue its synergy with AANA. We plan to make this an annual event to ensure that military surgeons are keeping up with the best arthroscopic techniques, education, and surgical skills,” said Dr. Provencher.

He also believes the collaboration between the two societies can serve as a model for other societies—and Drs. Tokish and Ryu agree.

“Because SOMOS is a multispecialty society, it would be natural to partner with the other specialties in which our members are actively engaged,” said Dr. Tokish.

“The AANA/SOMOS course is a great incentive for other societies to collaborate,” said Dr. Ryu. “There are strengths and weaknesses in all our groups and when we work together we can do great things—this course is one of them.”

Maureen Leahy is assistant managing editor for AAOS Now. She can be reached at leahy@aaos.org

Participants praise course content, master faculty

When asked to evaluate the AANA/SOMOS advanced shoulder arthroscopy course, participants said:

• “Great course, world-class faculty. As always, the Orthopaedic Learning Center is a phenomenal place to practice surgical techniques.”
• “Wow, I have never been around so many experts in my orthopaedic specialty. This was my first cadaver course as a resident—the hands-on learning was great. Thanks!”
• “As a chief resident, I gained a lot of practical/technical skills, as well as knowledge for my Orthopaedics in Training Exam (OITE)/Board scores.”
• “Incredible experience! The time and effort put forth by the AANA masters was very much appreciated.”
• “Excellent—exceeded my expectations; the discussions were great!”