Arthroscopy : The Journal of Arthroscopic and Related Surgery 3(4):265-268
Published by Raven Press, Ltd. © 1987 Arthroscopy Association of North America
History of the Arthroscopy Association of North America. Part I: Its Origin and Growth J o h n J. J o y c e , I I I , M . D . scells suggested that I obtain my own instrument and try using it myself. He had been kind enough to instruct me in the basics of the operation, Since I am a rather cautious soul, I used the Watanabe 21 instrument on about 50 cadaver knees before trying it on a patient. Thanks to the aid of Dr. Michael Harty from the University of Pennsylvania Anatomy Department, with whom I had worked for years, ! developed sufficient confidence to arthroscope patients. At first, the procedure was a purely diagnostic one. By early 1972, I was able to try some synovial biopsies and had removed a loose body from the knee of a teenager, who then had a rapid recovery. In the spring of 1972, I visited Dr. Jackson in Toronto. He was a very kind and patient host who demonstrated many helpful aspects of arthroscopy. During that visit, I also had the good fortune of meeting Dr. Kenneth DeHaven. Later that year I visited Dr. Watanabe in Tokyo, which was indeed a memorable experience. Not only did he demonstrate the use of the #21 Arthroscope, but he and his staff also provided an unforgettable visit to a geisha house. In addition, he demonstrated the use of his needle scope in the ankle and arranged for me to obtain one at the Nippon Glass Company in Osaka, Japan. The idea for a course in arthroscopy was the result of the combined efforts of Drs. Jackson, Casscells, Harty, and myself. An organizational meeting was held at the 1973 Annual Meeting of the American A c a d e m y of Orthopaedic Surgeons. P r e s e n t were Drs. J a c k s o n (who chaired the meeting), Casscells, Harty, Lanny Johnson, Robert Bechtol, and Harold Eikelaar. Arrangements for the seminar were made with the University of Pennsylvania, and a 1-day session was arranged on May 19, 1973. Its main emphasis was on the use of the instrument as a diagnostic tool. Drs. Jackson, Casscells, Harty, Edgar Ralston, Paul Lotke, and Wallace Miller made up the faculty. One of the most helpful features of the
Editor's comments: This is the last in a series o f four historical accounts o f our arthroscopic history. We will now have a permanent record for the future. Dr. John Joyce was primarily responsible for the formation of the International Arthroscopy Association (with A m e r i c a n , Asian, and E u r o p e a n chapters). It was established and incorporated in Philadelphia, Pennsylvania in 1974. In addition to documenting the history o f the formation of the International Arthroscopy Association, Dr. Joyce's meeting-by-meeting account takes us up to the Rio de Janeiro Meeting, at which time the Arthroscopy Association o f North America was formed (from the original American chapter). Before recounting the history of the formation of the International Arthroscopy Association (I.A.A.) and the North American Chapter of the I.A.A., which subsequently became the Arthroscopy Association of North America, I will make a few personal remarks about my initial introduction to this new and exciting field. My first introduction to arthroscopy was the result of my friendship with Ward Casscells and the fact that we lived only 30 miles apart. In addition, I'd had the good fortune to be present at the Combined Meeting of the Orthopaedic Associations of the English-Speaking World which took place in Sydney, Australia in 1970. At this meeting, Dr. Robert Jackson presented an excellent paper on his arthroscopic experiences. Although I had heard of the procedure previously, it was not generally accepted. The Jackson presentation and some informal discussions with Drs. Casscells and Jackson prompted me to refer some patients to Dr. Casscells in Wilmington, Delaware and to visit him on several occasions. After several visits, Dr. CasFrom the Department of Orthopaedic Surgery, University of Pennsylvania; Department of Orthopaedics, Germantown Hospital; Philadelphia, Pennsylvania. Address correspondence and reprint requests to John J. Joyce, III, M.D., 631 Lindley Road, Glenside, PA 19038, U.S.A.
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course was the provision of anatomy specimens by Dr. Harty. This provided a "hands-on" look at the various knee structures. The 75 participants were quite pleased with the session. The popularity of the course in 1973 led to many requests for a second seminar, so one was held in Philadelphia April 26-27, 1974. Our faculty was expanded to include Drs. Watanabe, Johnson, and Robert Freiberger, a radiologist from the Hospital For Special Surgery in New York. The faculty from the University of Pennsylvania included Drs. Ralston, Harty, Lotke, James Nixon, and myself. Approximately 200 participants attended the course. Thanks to Dr. Harty's ingenious anatomical arrangement of knee specimens, plus the generosity of both the Wolf and the Storz Companies, it was again possible for the students to have a close view of the scope in action. One of the highlights of the program occurred on the afternoon of the second day, when we were able to have Dr. Watanabe arthroscope a knee. By means of closed-circuit television, a black and white image was transmitted to the meeting hall. Although problems with static interference arose, the images were quite acceptable. A copy of the tape still exists. DEVELOPMENT OF THE ASSOCIATION The demand for further information about arthroscopy was created by Casscells's article in 1971 (1) and Jackson's article in 1972 (2) in the Journal of Bone & Joint Surgery, as well as our courses in 1973 and 1974. In 1973, Dr. H a r t y and I suggested to Drs. Jackson and Casscells that an international arthroscopy society be formed. Plans were made for an organizational meeting to be held on Sunday, April 28, 1974 in conjunction with the course in Philadelphia. Dr. Jackson had arranged for several papers to be presented. Among those on the program were Drs. Isao Abe (Tokyo), Alan Bass (Canada), Michete Aignan (Paris), Richard O'Connor (USA), Kenneth DeHaven (USA), Robert Bechtol (USA), and Serge Parisien (New York) who also translated for Dr. Aignan. Following the presentations, an organization meeting was held with Dr. Jackson acting as chairman. The officers elected were Drs. Masaki Watanabe, president; Robert Jackson, vice-president; Ward Casscells, secretary; and Richard O'Connor, treasurer. Drs. Lanny Johnson, Ralph Lidge, Kenneth DeHaven, John Joyce, Alan Bass, Arthroscopy, Vol. 3, No. 4, 1987
t t i r o s h i I k e u c h i , Jack McGinty, and M i c h e l e Aignan constituted the board of directors. Eighty physicians were recorded as founding members of the International Arthroscopy Association. The organization was legally established by representatives from the firm of Morgan, Lewis & Bockius of Philadelphia, Pennsylvania. It was also decided that American, European, and Asian chapters would be included in the I.A.A. Dr. Watanabe fortunately agreed to stay over long enough to address the Philadelphia Orthopaedic Society on April 29, 1974. He was welcomed by the group. In July 1975, the I.A.A. met in Copenhagen, Denmark. Dr. Watanabe presided. A delightful reception and dinner was sponsored by Dr: Watanabe on the first evening. On July 10th, Dr. Watanabe gave a welcoming speech followed by a paper on "Recent Advances In Arthroscopy." Presentations were made by a number of our members. A business meeting was held at which time the name of "International Arthroscopy Association" was approved. The corporation seal, designed by Dr. Robert Bechtot, was also adopted. On August 31, 1977, the first official meeting of the North American Chapter of I.A.A. was held in Denver, Colorado at Stouffer's Denver Inn. Presentations were made by Drs. Dinesh Patel (Boston), Michael Harty (Philadelphia), James Nixon (Philadelphia), Ralph Lidge (Arlington Heights), James Guhl, (Milwaukee), Lawrence Crane, (Portland), C. C. Carruthers (Ottawa), James Glick (San Francisco), J e r o m e L a w r e n c e ( N o r t h p o r t ) , Terry Whipple (Ashville), Gary Poehling (WinstonSalem), Douglas Jackson (Long Beach), Robert Carson (Salt Lake City), and Lanny Johnson (East Lansing). The meeting was well attended, and the facilities were excellent, thanks to the efforts of Dr. Robert Eilert. By this time, the ingenuity of Dr. R i c h a r d O'Connor had stimulated interest in the use of the arthroscope as an operating instrument as well as ~/ diagnostic tool. In 1974, his design of the operating scope, which was produced by the Wolf Company, resulted in a whole new outlook on operative arthroscopy. This was well reflected in the papers presented at the Third International Congress of I.A.A. in October 1978 in Japan. Although most papers dealt with diagnostic aspects of arthroscopy, presentations on the arthroscopic management of osteochondritis dissecans, surgery of the medial shelf, arthroscopic meniscectomies, synovectomy, and lateral retinacular release were some of the
HISTOR Y OF A R THR OSCOP Y A S S O C I A T I O N
subjects discussed. Thanks to Dr. Watanabe and his staff, this was indeed a most memorable and gala affair. At this meeting, new officers were elected. It was decided that there would be a p r e s i d e n t - - D r . Robert Jackson of Toronto, Canada; two vice-presid e n t s - D r . Isao Abe, Tokyo, Japan for Eastern Hemisphere, and Dr. John Joyce, III, Philadelphia, Pennsylvania for Western Hemisphere; secretary-Dr. S. Ward Casscells, Wilmington, Delaware; treas u r e r - D r . Richard O'Connor, West Covina, California; and archivist--Dr. Robert Bechtol, Santa Rosa, California. In May 1979, the second meeting of the North American Chapter of I.A.A. was held in Toronto, Canada with Dr. Jackson presiding. It was planned then to hold the next international meeting in Rio de Janeiro. I was appointed program chairman. Dr. Casscells announced that he was stepping down as secretary. A standing ovation expressed the gratitude of the membership for his years of service and his help in founding the organization. Dr. McGinty announced that his successor was Dr. Alan Bass of Hamilton, Ontario, Canada. In December 1979, the Executive Committee of I.A.A. met in Miami, Florida, and the decision was made to conduct continuing education courses in arthroscopic surgery under the aegis of I.A.A. As a result, a course in Long Beach, California was scheduled in December 1980 and another in Bermuda in April 1981. Dr. John McGinty was elected to direct the Continuing Education Program along with Drs. K e n n e t h D e H a v e n and Richard O'Connor. Plans were made for future meetings and courses. In October 1980, the Annual Meeting of the North American Chapter of I.A.A. was held in the Fairmount Hotel in Philadelphia under the chairmanship of myself. At this time, the affairs of the Arthroscopy Association were becoming so complex that a decision was made to obtain the services of a professional organization to handle our administrative tasks. As a result, Thomas Nelson and Associates was chosen to direct our affairs. Unfortunately, this arrangement was short-lived, as Mr. Nelson became the executive director of the American Academy of Orthopaedic Surgeons following the retirement of Dr. Charles Hecht, the long-time executive director. Arrangements were then made with Mr. Sanford Hill and his associates to run the association's affairs. This much needed arrangement brought order out of chaos and greatly simpli-
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fled the duties of the officers and directors of the association. In my presidential address, I proposed that due to the rapidly developing techniques in arthroscopy, a research committee should be formed with funds to encourage clinical as well as basic research. Such a committee was formed with Dr. Terry Whipple as chairman. The results have been stupendous. Funds for this program come from a portion of our dues as well as from the generous contributions of many of our exhibitors. The death in N o v e m b e r 1980 of Dr. Richard O'Connor, one of our founders and a pioneer in the development of arthroscopic instruments and surgical procedures, left the organization without a treasurer. An award in his memory has been underwritten by the generosity of the Wolf Instrument Company. His premature passing was a great loss to arthroscopy. Fortunately, Dr. Ralph Lidge of Arlington Heights, Illinois accepted the appointment to replace Dr. O'Connor. Dr. Lidge has been dedicated to the organization and has kept it on a stable, sound financial footing. The first instructional course of I.A.A., "Arthroscopic Surgery, An Advanced Course," was held in Long Beach, California December 3-5, 1980. The chairman was Dr. Douglas W. Jackson. The session was dedicated to Dr. Richard O'Connor. Dr. Robert Jackson, President of I.A.A., gave the dedication address and spoke on the "History and Future of I . A . A . " . Closed-circuit television was used to show "live" arthroscopic cases from the operating room. In April 1981, the second course sponsored by I.A.A., "Surgery of the Knee," was held in Bermuda at the Southhampton Princess H o t e l Drs. S. Ward Casscells and John McGinty were the course chairmen, and Dr. Colin Couper was in charge of the local arrangements. Both open and arthroscopic surgical procedures were discussed. Dr. David Dandy of England was appointed to the Educational Committee to fill the vacancy created by the demise of Dr. Richard O'Connor. In June 1981, a meeting of the long range planning committee was held in Chicago. It was suggested that I.A,A. organize two continuing education courses annually. One was to be held outside the United States, and the other in North America under the auspices of the American Chapter. At the Fourth Congress of I.A.A., held in August 1981 in Rio de Janeiro, the content of the papers presented changed. Not only was there more emArthroscopy, VoL 3, No. 4, 1987
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phasis on surgery with the arthroscope, but its use in other joints was discussed. Further subjects included the advantage of gas distention of joints and preliminary findings on the use of a laser as an experimental means of meniscectomy; both subjects were presented for the first time in the history of the organization. I had previously established awards for scientific papers, and the first awards were p r e s e n t e d to Drs. Terry Whipple, James Glick, and Ogilvie Harris. At the Rio de Janeiro Meeting, the following officers of the I.A.A. were elected: Isao Abe, president; John B. McGinty, vice-president; Alan Bass, secretary; Ralph Lidge, treasurer; and Robert Bechtol, archivist. Directors for Europe included David Dandy, FRCS, Nils Oretorp, M.D.; for North America Robert Carson, M.D., Robert Metcalf, M.D.; for Japan Hung Cheng Chert, M.D.; at large David Marshall, FRCS, Dinesh Patel, M.D. A new name for an old friend In addition to the meeting of the I.A.A. at Rio, the Board of Directors of the North American Chapter of I.A.A. also met because they felt that the function of the North American members would be better served by having a separate organization. Thus, the A r t h r o s c o p y Association of North America (A.A.N.A.) was formed with separate bylaws and its own dues structure, though ties were maintained to the I.A.A.
Arthroscopy, Vol. 3, No. 4, 1987
At this meeting of the Board of Directors of the North American Chapter of I.A.A., Drs. Robert Jackson, Alan Bass, Ralph Lidge, and myself were present along with guests Drs. John McGinty, James Guhl, Kenneth DeHaven, and Dr. Thomas Nelson. The following officers were elected: John McGinty, president; James Guhl, vice-president; Ralph Lidge, treasurer; and Alan Bass, secretary. The meeting was heightened by the m a n y changes in the organization as well as in the perspectives for use of the instrument, and by the delightful presidential reception and dinner. Dr. Robert Jackson was presented with an engraved silver tray in thanks for his excellent leadership. In December 1981, Dr. Ralph Lidge, treasurer, was directed by the A.A.N.A. Executive Committee to contact Dr. Robert Bechtol regarding the development of a logo for the association. The remaining history will be described in a future edition of the journal and will include all the important and some relatively unimportant events that transpired since 1981.
REFERENCES 1. Casscetls SW. Arthroscopy of the knee joint. A review of 150 cases. J Bone Joint Surg 1971;53A:287-98. 2. Jackson RW, Abe I. The role of arthroscopy in the management of the knee. An analysis of 200 consecutive examinations. J Bone Joint Surg 1972;54B:310-22.