Will rheumatologists ever pick up the arthroscope again?

Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. The post-War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra-articular features of their common diseases in the '60s and '70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the '90s with development of "needle scopes" that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features - such as a high prevalence of visible calcinosis - beg further arthroscopy-directed investigation. A new generation of "needle scopes" with far superior optics awaits future investigators, should they develop interest.

The Basis of Innovation: Depth, Breadth, and Tenacity.

The transition from open shoulder surgery to arthroscopic shoulder surgery represents a classic paradigm shift. In order for that paradigm shift to have occurred, the early pioneers in this discipline had to assume several burdens of their new craft: the burden of "arthroscopic identification"; the burden of developing the language of arthroscopy; the burden of disseminating arthroscopic knowledge; the burden of developing safe arthroscopic instruments and implants; and the burden of proving biomechanical and structural equivalency between arthroscopic and open constructs. Embracing these obligations, they were able to produce the paradigm shift to arthroscopic shoulder surgery through a spirited mix of depth, breadth, and tenacity, defying long odds and conventional wisdom while creating a major breakthrough in shoulder surgery.

Arthroscopy Annual Awards, a 35th Anniversary and More.

With sincere appreciation to the Arthroscopy Association of North America Education Foundation for their generous support, we announce our 2020 Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2019, as well as the Most Downloaded and Most Cited papers published 5 years ago. Our January cover is a throwback in honor of the 35th anniversary of our journal, and our cover will sport a festive banner each month this year. We introduce our 2020 masthead and team, including a new Social Media Board. Finally, our Editor-in-chief, Assistant Editors, and Associate Editors update their disclosures of potential conflicts of interest.

The history of suture anchors in orthopaedic surgery.

The suture anchor allows secure fixation of soft tissue to bone and has become an invaluable tool for the orthopaedic surgeon. The original suture anchor was developed over 3 decades ago when a suture was bonded to a headless screw. Since then anchors have undergone a wide variety of design modifications to increase strength and allow for new applications based on biomechanical and clinical evidence. The suture anchor chain consists of the anchor to bone fixation, anchor suture interface, suture itself and suture to soft tissue interface. The early suture anchors failed most commonly from anchor pull out or breakage, with the strongest early design being a bone-screw-suture complex. Early concerns of metalwork complications saw the introduction of biodegradable suture anchors, originally lactic acid polymers and then osteoconductive bio-composites. Improvements in anchor design saw the suture become the main link of failure until the advent of novel suture materials made of ultrahigh molecular weight polyethylene. A form failure of suture at the anchor eyelet via cut-out led to redesign of the anchor suture interface with novel eyelet designs. Further innovations in the anchor suture interface have seen the advent of knotless anchors, especially useful in arthroscopic surgery. The newest products are all-suture anchors which show impressive strength whilst reducing the iatrogenic damage caused by insertion. The further biomechanical development of suture anchors is likely to produce new designs that continue to increase strength whilst managing size requirements for tailored clinical applications.

Historical review of arthroscopic surgery of the hip.

BACKGROUND & PURPOSE: Increasing our appreciation of the historical foundations of hip arthroscopy offers greater insight and understanding of the field's current and future applications. This article offers a broad history of the progress of hip arthroscopy. METHODS: Hip arthroscopy's development from the early technologies of endoscopy to the present day is described through a review of the available literature. RESULTS: Endoscopic science begins with the Lichtleiter, developed by Phillip Bozzini (1779-1809) in 1806, but endoscopes were not applied to joints until 1912, as presented by Severin Nordentoft (1866-1922). The work of Kenji Takagi (1888-1963), especially, was instrumental in the arthroscope's development, allowing Michael Burman (1901-75) to perform the first recorded hip arthroscopy, detailed in a 1931 paper after extensive cadaveric research. Although World War II stalled further development, a renewed application of fibre optics following post-war innovations in glass manufacture heralded the modern arthroscope's invention. During the 1970s hip arthroscopy was first mobilized for diagnosis and exploration, leading to its later adoption for therapeutic surgical interventions. Modern hip arthroscopy has been facilitated by international research into optimum distraction, portals of entry, positioning of patients, and the technology of arthroscopic instruments. In 2008, the International Society for Hip Arthroscopy (ISHA) was founded to represent this international expert community. CONCLUSIONS: Technology, communication and evidence-based medicine have jointly facilitated the development of this young but promising corner of Orthopaedics.

Romanian medicine, European medicine.

The aim of the present paper is to present the message transmitted by the Presidential Lecture given during the first congress of arthroscopy organised in Romania, in March 2016, by the Romanian Society of Arthroscopy and Sports Trauma (SRATS). The goal was to present the evolution of medical care in Romania over the years, with the remarkable progress made in the first half of the twentieth century and the current status of arthroscopic surgery as seen from the point of view of medical professionals, as well as from a governmental point of view.

The Evolution of the Surgical Treatment of Sports Injuries in the 20th Century: A Historical Perspective.

Sports injuries have been a major issue in medicine, surgery, and especially in orthopedics since the classical antiquity era. The 20th century, with its progress and innovations, changed the general concept of treating these injuries forever. The purpose of this review is to show how innovations in surgery in the 20th century changed the rationale of treating sports injuries. In this historical review, we present innovations concerning fracture treatment, spine injury treatment, and anterior cruciate ligament reconstruction related to sports injuries. In addition, we present and record those surgical techniques and the pioneer surgeons who first used them.

Hip Arthroscopy: A Brief History.

Hip arthroscopy is a fast-growing and evolving field. Like knee and shoulder arthroscopy, hip arthroscopy began as a diagnostic procedure and then progressed to biopsy and resection of abnormalities. Subsequently, it has evolved to repair of various tissues and treatment of underlying causes. As the understanding of the hip joint and its associated pathophysiology grows, indications will continue to expand for this diagnostic and therapeutic modality. This article outlines the historic developments of hip arthroscopy, including advancements in instrumentation and techniques from the days of the first hip arthroscopies to the present day.

History of surgical intervention of anterior shoulder instability.

BACKGROUND: Anterior glenohumeral instability most commonly affects younger patients and has shown high recurrence rates with nonoperative management. The treatment of anterior glenohumeral instability has undergone significant evolution over the 20th and 21 centuries. METHODS: This article presents a retrospective comprehensive review of the history of different operative techniques for shoulder stabilization. RESULTS: Bankart first described an anatomic suture repair of the inferior glenohumeral ligament and anteroinferior labrum in 1923. Multiple surgeons have since described anatomic and nonanatomic repairs, and many of the early principles of shoulder stabilization have remained even as the techniques have changed. Some methods, such as the Magnusson-Stack procedure, Putti-Platt procedure, arthroscopic stapling, and transosseous suture fixation, have been almost completely abandoned. Other strategies, such as the Bankart repair, capsular shift, and remplissage, have persisted for decades and have been adapted for arthroscopic use. DISCUSSION: The future of anterior shoulder stabilization will continue to evolve with even newer practices, such as the arthroscopic Latarjet transfer. Further research and clinical experience will dictate which future innovations are ultimately embraced.

History of shoulder instability surgery.

PURPOSE: The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. METHODS: A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. RESULTS: The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. CONCLUSIONS: The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. LEVEL OF EVIDENCE: IV.

The Role of Arthroscopy in the Management of Tibial Plateau Fractures.

Arthroscopy has been advocated as a possible adjunct to the operative treatment of tibial plateau fractures. This review article provides a historical perspective on the development of the technique while focusing on its current role in the management of these injuries. Topics include the possible utility of employing arthroscopy in the diagnosis and management of associated soft tissue lesions and potential for arthroscopic assistance to facilitate achieving fracture reduction without an open arthrotomy. Pertinent literature is reviewed and discussed, with an emphasis on the data related to patient outcomes.

Change is a Constant.

In 2015, Henry P. Hackett, Managing Editor, Arthroscopy, retires, and Edward A. Goss, Executive Director, Arthroscopy Association of North America (AANA), retires. Association is a positive constant, in a time of change. With change comes a need for continuing education, research, and sharing of ideas. While the quality of education at AANA and ISAKOS is superior and most relevant, the unique reason to travel and meet is the opportunity to interact with innovative colleagues. Personal interaction best stimulates new ideas to improve patient care, research, and teaching. Through our network, we best create innovation.

A review of arthroscopic classification systems for osteochondritis dissecans of the knee.

Multiple systems for classifying osteochondritis dissecans (OCD) of the knee have been reported. These existing classification systems have some similar characteristics, such as stable lesion/intact articular cartilage and presence of a loose body. However, variations are found in the number of stages and specific lesion characteristics assessed. Currently, no system has been universally accepted. A future classification system should be developed that reconciles the discrepancies among the current systems and provides a clear, consistent, and reliable method for classifying OCD lesions of the knee during arthroscopy.

Hip arthroscopy: from the beginning to the future--an innovator's perspective.

Hip arthroscopy is one of the fastest-growing areas of orthopaedic surgery. There are many reasons for this, including a better understanding of the pathophysiology of damage to the hip joint, improvements in imaging and technology advancements in arthroscopic instrumentation. This manuscript documents the historical development of hip arthroscopy, in general, as well as advances and ideas that have led to common techniques with regard to portal placement, traction and instrumentation. These advances have led to expanding indications for hip arthroscopy. This manuscript ends with some thoughts about the future of hip arthroscopy from the perspective of one of the leaders who helped shape hip arthroscopy, as it is performed today.

Surgery for anterior cruciate ligament deficiency: a historical perspective.

The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed was a period of startling ingenuity which created an amazing variety of different surgical procedures often based more on surgical fashion and the absence of a satisfactory alternative than any indication that continued refinements were leading to improved results. It is hence not surprising that real inventors were forgotten, good ideas discarded and untried surgical methods adopted with uncritical enthusiasm only to be set aside without further explanation. Over the past 100 years, surgeons have experimented with a variety of different graft sources including xenograft, and allografts, whilst autologous tissue has remained the most popular choice. Synthetic graft materials enjoyed temporary popularity in the 1980 and 1990s, in the misguided belief that artificial ligaments may be more durable and better equipped to withstand stresses and strains. Until the 1970s, ACL reconstructions were considered formidable procedures, often so complex and fraught with peril that they remained reserved for a chosen few, never gaining the level of popularity they are enjoying today. The increasing familiarity with arthroscopy, popularised through Jackson and Dandy, and enhancements in surgical technology firmly established ACL reconstruction as a common procedure within the realm of most surgeons' ability. More recently, the principle of anatomic ACL reconstruction, aiming at the functional restoration of native ACL dimensions and insertion sites, has been introduced, superseding the somewhat ill-advised concept of isometric graft placement. Double-bundle reconstruction is gaining in popularity, and combined extra- and intra-articular procedures are seeing a revival, but more accurate and reliable pre- and post-operative assessment tools are required to provide customised treatment options and appropriate evaluation and comparability of long-term results. Modern ACL surgery is united in the common goal of re-establishing joint homoeostasis with normal knee kinematics and function which may ultimately assist in reducing the prevalence of post-operative joint degeneration. This review hopes to provide an insight into the historical developments of ACL surgery and the various controversies surrounding its progress. Level of evidence V.