Surgeons and physiotherapists collaborate to demonstrate best practice in treating shoulder injuries
This year, 2016, saw the fifth year of a successful meeting of minds of both surgeons and physiotherapists treating shoulder injuries and conditions, at the QE Hospital in Birmingham. Hosted by Mr Socrates Kalogrianitis, an impressive faculty of experts not only presented on a range of topics but many of them shared tips and tricks alongside descriptive narration of the live surgical procedures they were performing, viewed by the audience in crystal-clear high definition utilising Arthrex SynergyHD3 camera systems, from theatre to lecture room.
Instability and rotator cuff repair were the topics that started the day with Mr Peter Brownson setting a general theme by highlighting the importance of surgeons and physios working together for the best approach and treatment of each patient, reviewing and summarising his choices, based on his experience. Mr Carlos Cobiella undertook the first surgery of the day, accomplishing a secure instability repair on a young female recurrent dislocating patient utilising an all knotless technique with BioComposite PushLock® anchors and the Labral Scorpion™.
Mrs Jo Gibson followed with an in-depth talk primarily on type II and III cases and the considerations of treatment of multidirectional instability – when and if to operate. She reiterated Mr Brownson’s earlier comments on the value of surgeon and physio cooperation and the importance of rehab, especially in cases where surgery may not, in fact, be the answer.
Mr Graham Tytherleigh-Strong’s presentation set the scene for the next surgery, rotator cuff repair (RCR), by reviewing the current thinking on RCR, looking at failures and how to optimise the chances of a rotator cuff healing. He also reminded the audience to consider the training opportunities available, the range of technical equipment for both viewing and suture passing, along with the implants available and the option of the use of PRP or patches for biologically aided healing. Mr Rohit Gupta followed with an impressive demonstration of an RCR procedure on a patient with both a subscapularis and supraspinatus tear, impressing the audience not only with his efficient and precise technique but with his step-by-step commentary throughout the procedure on portal placement, suture management and tensioning with the BioComposite SwiveLock® anchors and FiberTape® for the SpeedBridge® technique.
The third live surgery of the day saw Mr Socrates Kalogrianitis complete an arthroscopic bone block procedure on a 25-year-old male kickboxer who had experienced bilateral dislocations 30–40 times since his first dislocation. There was approximately 15 per cent loss of the anterior inferior aspect of the glenoid, which was reconstructed with an iliac crest graft, taken and prepared in advance. Prior to the operation Mr Kalogrianitis gave the audience food for thought by presenting, via live link from theatre, on the benefits and drawbacks of the differing Laterjet and bone block techniques performed arthroscopically. The procedure was expertly completed without issue, demonstrating a novel minimally invasive method for bone block procedures.
The afternoon session saw the physios split from the group to enable them to engage in some very useful and lively discussion, led by Ms Nicola Birch, Dr Rachel Chester and Mrs Jo Gibson. Topics included prognostic factors for physiotherapy outcome, consideration on when treatment isn’t working in cases of atraumatic instability, and also a group discussion on what could be done better for patients rehabilitating from stabilisation surgery.
The surgeons’ day progressed to include three further live surgeries: a sub-pectoral biceps tenodesis, performed expertly by Mr Graham Tytherleigh-Strong, on which topic Mr Carlos Cobiella had presented earlier; a challenging superior capsule repair (SCR) case, by Mr Kalogrianitis, highlighting a novel joint preservation technique for treating extensive irreparable cuff injuries; and a chronic ACJ case on a motorcyclist, for which Mr Angus Robertson pre-prepared the ACJ graft and took the audience straight to the main part of the operation, handling a few tricky moments expertly and keeping the audience enthralled to the end.
These surgeries were all complemented by further talks and discussion including Mr Andrew Brooksbank expertly describing the SCR technique prior to assisting Mr Kalogrianitis in theatre on the same. Likewise Mr Gupta reviewed the classifications of ACJ and looked at the treatment options for both acute and chronic indications, including use of the AC TightRope™ and the Dog Bone™ Button for acute type IV and V patients, prior to the live case. Mr Gupta also presented on the use of Partial ECLIPSE™, looking at case studies and offering tips and tricks for this minimally invasive arthroscopic assisted arthroplasty technique.
The feedback from the course was the best yet and Arthrex look forward to bringing you more fascinating live surgery and discussion opportunities in future.