Live at the Queen Elizabeth
Surgeons and physiotherapists witnessed live surgery and state-of-the-art techniques at the fourth Live Shoulder Arthroscopy seminar, held in Birmingham in March
The Queen Elizabeth Hospital Birmingham (QE) is the largest single site hospital in the UK providing clinical services to close to one million patients and to all seriously injured military personnel returning from overseas. On Saturday 7 March 2015 the QE hosted the fourth Live Shoulder Arthroscopy seminar, supported by the British Orthopaedic Association and the European Society for Shoulder and Elbow Rehabilitation (EUSSER) and sponsored by Arthrex.
Approximately 100 surgeon and physiotherapist delegates attended the event to witness live surgery and presentations on current state-of-the-art and novel arthroscopic techniques. The surgeries were viewed by the audience in crystal-clear high definition, utilising Arthrex SynergyHD3 camera systems, through live video and audio links from two operating theatres. This allowed delegates excellent opportunities to observe and interact with renowned surgeons while they performed a range of arthroscopic techniques on common shoulder pathologies.
Guest speaker Dr Alan Hirahara M.D. (Sacramento, California) started the day with a tour de force lecture on rotator cuff repair – from partial thickness tears, detailing his innovative PASTABridge technique, to full thickness tears utilising double-row knotless SpeedBridge™ techniques, and, finally, arthroscopic patch augmentation techniques with DX Matrix™ for massive tears with poor-quality tissue. The presentation was immediately followed by two rotator cuff repair surgeries.
The first live surgery, performed by Mr Andrew Brooksbank (Glasgow Royal Infirmary), was a traumatic cuff tear on a 35-year-old male weightlifter. Mr Brooksbank utilised the SutureBridge™ technique, during which he illustrated the benefits of good suture management; he inserted two Corkscrew FT anchors medially and used the new Side Loading FastPass Scorpion™ to pass his sutures before completing the repair with self-punching, vented SwiveLock anchors laterally. The direct dialogue with the audience allowed discussion of the merits and benefits of the technique. This was followed by the second live surgery, with Mr Socrates Kalogrianitis (QE Birmingham) demonstrating how he uses the SpeedBridge™ technique for a large cuff repair utilising BioComposite SwiveLock® anchors and FiberTape® to repair a difficult and delaminated supraspinatus tear and a subscapularis tear, in a 65-year-old male patient.
To complete the morning session, Mr Graham Tytherleigh-Strong (Cambridge) presented on the first-time dislocator, outlining the implications for future issues facing young patients with this injury and the potential treatments and operative intervention. This session featured lively discussion and interaction between the presenter and both physios and surgeons in the audience. Mr Tytherleigh-Strong’s presentation led neatly into the third surgery of the day – a 32-year-old female recurrent dislocator with anterior instability. Mr Peter Brownson (Royal Liverpool and Broadgreen University Hospitals) shared his thoughts and decision-making on what action was required with this patient before showing his surgical skills and use of the new Arthrex ReelPass™ lasso, LabralTape™ and Pushlock® anchors for the knotless Bankart repair. In one of the more humorous moments of the day, Mr Brownson requested a toffee hammer for anchor insertion and then exclaimed “Wow! Now that’s a hammer!” as the scrub nurse handed him a huge mallet more closely resembling Thor’s hammer.
After a break for lunch, Professor Gordon Mackay (Ross Hall Hospital, Glasgow) presented on the novel InternalBrace™ concept, which allows for faster patient rehabilitation and return to sport in a variety of applications in ankle, knee and shoulder procedures. This set the scene for the subsequent surgery where Mr Kalogrianitis and Prof Mackay worked together on the chronic ACJ disruption of a 20-year-old rugby-playing patient, using the Arthroscopic DogBone™ and AC GraftWrap together with an AC InternalBrace with SwiveLock anchors and FibreTape.
The next didactic presentation by Dr Hirahara was a new surgical technique for the management of the irreparable cuff tear – arthroscopic superior capsular reconstruction. Dr Hirahara explained the development of his current technique (evolving from the published work of Dr Teru Mihata, Osaka, Japan) and shared research studies and recommendations. This emerging procedure is ideal for the younger patient with an irreparable superior cuff and no osteoarthritis. The novel arthroscopic procedure can be completed in under an hour with superior functional outcomes and fewer complications than a reverse prosthesis.
The penultimate live surgery of the day was an arthroscopic proximal biceps tenodesis of a patient who was a cabinet-maker and archery player and had undergone previous surgery. Mr Carlos Cobiella (University College Hospital, London) expertly completed the procedure while engaging the audience in a hot topic discussion on the location of the biceps tendon tenodesis site, completing a secure all-arthroscopic biceps tenodesis with the forked-tip Biceps SwiveLock anchor system.
Prior to the last surgery of the day, Mr Steve Drew (University Hospitals Coventry and Warwickshire) presented on subscapularis repair and Tom Dooney from Arthrex Inc. (Naples, Florida), gave an update on ‘What’s New’ from Arthrex.
The event ended with the sixth and final surgery of the day which involved a posterior bone block stabilisation, performed by Mr Socrates Kalogrianitis and Mr Graham Tytherleigh-Strong. An interesting case to many, this was a cerebral palsy patient in his early 20s who was experiencing multiple posterior shoulder dislocations each day and thus required surgical intervention. The surgeons demonstrated the preparation and placement of the iliac crest graft bone block, illustrating the difficulty and skill required, and prompted interactive discussion with the audience on the decisions involved when undertaking an arthroscopic bone block procedure.
Delegate feedback was excellent, and left participants with new ideas, tips and tricks for the procedures viewed, as well as new techniques of interest ‘To help treat their patients better.’