- Email: [email protected]
The old order changeth
Traveling Fellowship Report
The Old Order Changeth Dinshaw N. Pardiwala, M.S.(Orth), D.N.B., F.C.P.S.
I
n the early 1970s, a small group of pioneers advanced the theory that by performing joint surgery through an arthroscope, the orthopaedist could reduce morbidity and enhance rehabilitation. Through the determination and persistence of these visionaries, and the concomitant developments in instrumentation, all joints at present are arthroscopically accessible, and most procedures performed open can be performed equally well or better arthroscopically. Although arthroscopic surgery has advanced to heights unimaginable a few decades back, this progress has not been universal. Developing nations, such as India, although adept in the techniques and advances of open surgery, were late in veering to the arthroscopic route. Skepticism of the new concept, and expensive imported instrumentation are the oftcited reasons for this. However, the most important reason is probably the lack of adequate education and training in arthroscopic techniques. Most postgraduate orthopaedic residency programs in India, even today, do not impart formal instruction with supervised practice in arthroscopy, and most arthroscopists are selftaught. The Arthroscopy Traveling Fellowship sponsored by Arthroscopy Association of North America and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine is, therefore, an unparalleled educational opportunity for surgeons such as me to acquire training in arthroscopy and then to disseminate the knowledge and enhance the spe-
From the Departments of Orthopaedics, King Edward VII Memorial Hospital and the University of Mumbai, Mumbai, India. Address correspondence and reprint requests to Dinshaw N. Pardiwala, M.S.(Orth), D.N.B., F.C.P.S., Jiwan 7A, 11 Ruparel Road, Malabar Hill, Mumbai 400006, India. E-mail: [email protected] © 2001 by the Arthroscopy Association of North America 0749-8063/01/1709-3130$35.00/0 doi:10.1053/jars.2001.28927
cialty locally. I am deeply grateful to the visionaries who developed this fellowship and would like to thank the surgeons with whom I was fortunate to be associated and from whom I learned so much. Nuffield Orthopaedic Centre, Oxford, England My fellowship commenced at Nuffield Orthopaedic Centre in Oxford, England. After a gracious welcome by Professor John Kenwright, I joined the Shoulder and Elbow Service and was associated with Professor Andrew Carr. Nuffield Orthopaedic Centre is an outstanding institute, known not only for its rich traditions in patient care and orthopaedic rehabilitation, but also for its research and training programs. In the clinics I was exposed to a spectrum of shoulder and elbow problems, and had the opportunity to examine many patients with impressive long-term results of shoulder and elbow arthroplasty. In India, 4 to 6 joint replacements in a single patient are rare, and hence, I was often taken aback on meeting patients with replacements of both shoulders, elbows, hips, knees, and ankles! The clinics also gave me an opportunity to observe and learn the effective and judicious use of diagnostic ultrasonography of the shoulder. I had the opportunity to assist Mr. Carr in numerous surgical procedures. These included shoulder arthros-
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 981–984
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copy, elbow arthroscopy, primary and revision shoulder arthroplasty, primary and revision elbow arthroplasty, as well as other open surgical procedures. I was particularly impressed with the effortless finesse with which Mr. Carr performed open Bankart repair with capsular shift for shoulder instability, and eagerly accepted the many ‘tips and tricks’ he offered. It was also my first exposure to elbow arthroscopy and Mr. Carr clearly demonstrated its role and effectiveness. During my 5 weeks at Nuffield Orthopaedic Centre I was fortunate to work with other surgeons too. I assisted Mr. Christopher Dodd of the Knee Service in numerous arthroscopic ACL reconstructions, besides other knee arthroscopic surgeries. Being accustomed to using autograft patellar tendon for ACL reconstructions, I was mildly surprised to learn that all the surgeons at this institute preferred the quadrupled hamstring tendon as their autograft of choice. At Nuffield I was also exposed to the world of unicondylar knee replacements, which although new to me, had been performed at this institute for many years. Although the surgical technique appeared demanding and quite unforgiving if performed inaccurately, I was impressed with many of the excellent results I saw. I also spent a few days working with Mr. Paul Cook, the Ankle and Foot specialist at Nuffield, and was amazed at the volume of ankle arthroscopy that was referred to him. My exposure to ankle arthroscopy was limited and assisting him was a great learning experience. The ankle arthroscopic procedures I learned included excision of bony impingement, debridement of soft-tissue impingement, loose body removal, treatment of osteochondritis dissecans, and ankle arthrodesis. Wrist arthroscopy too was new to me, and I was fortunate to observe a few diagnostic and therapeutic wrist arthroscopic procedures being performed by Mr. Peter Burge.
Hospital, was a revelation. I had first-hand exposure to diagnostic and therapeutic hip arthroscopy and managed to assimilate many of the finer technical details that make the procedure less daunting. The cases in which I saw remarkable relief of symptoms included resection/debridement of inverted labral tears with impingement, removal of loose bodies and osteochondral fragments, and debridement and lavage of early osteoarthritic joints. With Mr. Villar, I was also exposed to hip resurfacing arthroplasty, which seems to be having a surge in popularity at some centers in the United Kingdom and the United States. My short stint with Mr. Villar was enriching not only because of the hip arthroscopy, but also because of the many small tips on managing hip disorders that I picked up from him during clinics and ward rounds. While in Cambridge I had the distinct privilege of working with Mr. David Dandy for a day. It was Mr. Dandy’s well-illustrated book Arthroscopic Management of the Knee that had first got me interested in the subspecialty during my residency, and this occasion was therefore special for me. Besides assisting him in surgery, we had a lengthy discussion on the management of patellofemoral instability and his personal philosophy on ACL reconstruction. I was amazed to learn that even today he rarely if ever uses motorized instruments during arthroscopic procedures. During my academic travels in the United Kingdom, I was invited to visit the Museum of Anatomy and Surgery at the Royal College of Surgeons in Edinburgh. Recounting the rich historical beginnings of medicine as a whole, and the development of surgery and orthopaedics over the ages, the museum has a collection of some of the finest original anatomical dissections and pathological specimens. It was an unforgettable experience.
Addenbrookes Hospital and Cambridge Lea Hospital, Cambridge, England
Hospital for Special Surgery, New York City
Although I had been performing knee, shoulder, and ankle arthroscopy prior to commencing my fellowship, the intriguing world of hip arthroscopy had eluded me. I often wondered if it was technically feasible to negotiate an arthroscope within the hip joint, and if so, what therapeutic benefits it could achieve. The next surgeon I visited convincingly dispelled any doubts I had of the procedure and its role in sports medicine today. Working with Mr. Richard Villar for a month at Addenbrookes Hospital, Cambridge, and the Hip and Knee Unit, Cambridge Lea
The Hospital for Special Surgery in New York City has been at the forefront of sports orthopaedics for many years and here it was an honor to be associated with some of the greats of the field. Dr. Russell Warren, with whom I was primarily associated, taught me his methodical approach to shoulder and knee arthroscopy and, in assisting him with these procedures, I gained through his years of experience. In addition to the entire gamut of sports-related knee and shoulder problems, I was exposed to many procedures new to me. These included the use of osteochondral allografts for chondral defects of the knee, autogenous
TRAVELING FELLOWSHIP REPORT chondrocyte implantation, revision ACL reconstruction, the use of tendon allografts for multiligament knee reconstructions, and thermal capsular shrinkage for shoulder instability. From him I also gained a deeper understanding of meniscal repair and the various means to achieve this. My six weeks at the Hospital for Special Surgery gave me an ample opportunity to learn from the many experts there. Dr. Edward Craig taught me the finer aspects of arthroscopic subacromial decompression and mini-open rotator cuff repair. From Dr. David Altchek I learned the importance of precise methodology and standardization of technique, be it for ACL reconstruction or arthroscopic shoulder stabilization. He also taught me his technique for ulnar collateral ligament reconstruction of the elbow. Beside demonstrating his transverse incision for ACL reconstructions, Dr. Thomas Wickiewicz offered numerous tips on meniscal repair techniques. From Dr. Frank Cordasco I learned the art of performing routine procedures precisely and effortlessly. He also taught me arthroscopic shoulder stabilization using suture anchors, repair of SLAP lesions, and arthroscopic rotator cuff repair. I also had the opportunity to observe Dr. Andrew Weiland performing wrist arthroscopy and arthroscopic carpal tunnel release, Dr. Martin O’Malley performing arthroscopy of the ankle and subtalar joints, and Dr. Robert Buly performing hip arthroscopy. In addition to learning a significant amount from the ongoing discussions in the operating room and clinics, I gained a great deal of knowledge from the morning conferences and academic programs. These included not only sessions on the basic sciences and sports radiology, but also extremely interesting seminars on revision ACL reconstruction, reconstructive techniques for chondral defects, and the management of failed extra-articular open shoulder stabilization. I also appreciated the enthusiasm of the extremely knowledgeable operating room staff, especially “Tommy,” Stash, and Willie, who introduced me to the technical details of the newest instrumentation for arthroscopic rotator cuff repair, meniscal repair, and osteochondral allograft transplantation. The American Sports Medicine Institute and the Alabama Sports Medicine & Orthopaedic Center, Birmingham, Alabama The last month of my fellowship was spent at the American Sports Medicine Institute. My experience here included not only the clinical and surgical
983
aspects of orthopaedic injuries in sports, but also an overall exposure to primary health care in sports medicine, sports medicine research, and sports rehabilitation. The guided tour of the Institute that Mr. Dale Baker gave me on my arrival convinced me that this was a comprehensive and integrated sports institute like none other I had ever seen. The facility included extensive and elaborate clinics and operating rooms, a high-tech sports rehabilitation center, research labs, and a motion analysis lab for studying sports actions. With Dr. James Andrews, I had the opportunity of learning the arthroscopic and open treatment of the entire range of shoulder and elbow problems in throwing athletes. This included a spectrum of unstable shoulders treated arthroscopically or with open capsulolabral repair, revision shoulder stabilization procedures, a vast number of arthroscopic elbow procedures, and ulnar collateral ligament reconstruction of the elbow. My stint with him also exposed me to his techniques for pediatric ACL reconstruction, open repair for posteromedial meniscocapsular disinsertion, the all-inside repair of meniscal injuries using bioabsorbable meniscal screws, and arthroscopic fixation of osteochondral fragments. I also had the opportunity of working with Dr. William Clancy, and learned his “anatomic ACL reconstruction,” 2-bundle PCL reconstruction, revision ACL reconstruction with contralateral patellar tendon, and pediatric ACL reconstruction. A large number of sports conferences and interactive teaching sessions were held during my stay at the American Sports Medicine Institute. These included ACL injuries in immature athletes, revision ACL reconstruction, meniscal repair, multiligament knee reconstruction, arthroscopic subacromial decompression, peak performance in golf, and the biomechanics of throwing. Working at the American Sports Medicine Institute was an excellent experience. This was due in part to the interesting primary and revision sportsrelated cases I was involved with in the clinics and the operating room, but also because I was exposed to an integrated approach to sports injuries that included an active participation in the postoperative rehabilitation of athletes. I also had the opportunity to accompany the orthopaedic sports medicine fellows to high school and college football games and involve myself in the primary care of injuries on the playing field.
984
D. N. PARDIWALA
My Goals My educational goals for this fellowship included: 1. To learn the recent advances in operative arthroscopy of the knee, especially with regard to: ● Arthroscopic PCL reconstruction ● Posterolateral corner and multiple ligament reconstructions ● The treatment of chondral defects using autologous chondrocyte implantation and osteochondral allograft techniques ● The use of meniscal allografts 2. To improve my skills in shoulder arthroscopy and learn new techniques, especially with regard to: ● Arthroscopic management of shoulder instability ● Arthroscopic rotator cuff repair ● Arthroscopic SLAP lesion repair ● Thermal capsular shrinkage 3. To learn the current concepts in operative ankle arthroscopy, particularly post-traumatic chondral and osteochondral lesions. 4. To gain an exposure to and learn the techniques of arthroscopy of the hip, elbow, and wrist and to observe its application and results. The Arthroscopy Traveling Fellowship enabled me to achieve all these goals, and much more. I learned recent advances and new techniques, had an opportunity to interact with the masters in the field, shared discussions with orthopaedic surgeons from other backgrounds, and most importantly, made friends for
life. These included not only the numerous surgeons I worked with and learned from, but also the many visiting orthopaedic surgeons of various nationalities whom I met during my travels. Although the Arthroscopy Traveling Fellowship was an enriching experience for me as an individual, the benefits of this educational exposure will be apparent more widely. The knowledge and skills that I have acquired are being disseminated to many more arthroscopists, orthopaedic surgeons, and residents-intraining via teaching programs and workshops. Moreover, my fellowship experience is making a difference to those to whom it matters most: the athletes and other patients. The results are evident; the sports medicine service at my university hospital is already experiencing a spiraling trend in the number and range of arthroscopic procedures being performed. A concerted effort to spread the techniques, knowledge, and expertise to other hospitals and to nonurban areas is also taking shape. A lack of appropriate training opportunities had resulted in arthroscopy being a neglected subspecialty in India for a long time. The fellowship experience that I have gained is empowering me to change this scenario and enhance the specialty locally. The old order finally changeth. In his Presidential Speech presented at the 16th Annual Meeting of the Arthroscopy Association of North America, Dr. Joe Tippett proclaimed, “AANA does not let anything stand in the way of the education of its members and nonmembers alike. In the last 10 years our primary concern has been to educate . . .” AANA has lived up to its goals and promises. Thank you for this unique opportunity!
The Old Order Changeth Dinshaw N. Pardiwala, M.S.(Orth), D.N.B., F.C.P.S.
I
n the early 1970s, a small group of pioneers advanced the theory that by performing joint surgery through an arthroscope, the orthopaedist could reduce morbidity and enhance rehabilitation. Through the determination and persistence of these visionaries, and the concomitant developments in instrumentation, all joints at present are arthroscopically accessible, and most procedures performed open can be performed equally well or better arthroscopically. Although arthroscopic surgery has advanced to heights unimaginable a few decades back, this progress has not been universal. Developing nations, such as India, although adept in the techniques and advances of open surgery, were late in veering to the arthroscopic route. Skepticism of the new concept, and expensive imported instrumentation are the oftcited reasons for this. However, the most important reason is probably the lack of adequate education and training in arthroscopic techniques. Most postgraduate orthopaedic residency programs in India, even today, do not impart formal instruction with supervised practice in arthroscopy, and most arthroscopists are selftaught. The Arthroscopy Traveling Fellowship sponsored by Arthroscopy Association of North America and the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine is, therefore, an unparalleled educational opportunity for surgeons such as me to acquire training in arthroscopy and then to disseminate the knowledge and enhance the spe-
From the Departments of Orthopaedics, King Edward VII Memorial Hospital and the University of Mumbai, Mumbai, India. Address correspondence and reprint requests to Dinshaw N. Pardiwala, M.S.(Orth), D.N.B., F.C.P.S., Jiwan 7A, 11 Ruparel Road, Malabar Hill, Mumbai 400006, India. E-mail: [email protected] © 2001 by the Arthroscopy Association of North America 0749-8063/01/1709-3130$35.00/0 doi:10.1053/jars.2001.28927
cialty locally. I am deeply grateful to the visionaries who developed this fellowship and would like to thank the surgeons with whom I was fortunate to be associated and from whom I learned so much. Nuffield Orthopaedic Centre, Oxford, England My fellowship commenced at Nuffield Orthopaedic Centre in Oxford, England. After a gracious welcome by Professor John Kenwright, I joined the Shoulder and Elbow Service and was associated with Professor Andrew Carr. Nuffield Orthopaedic Centre is an outstanding institute, known not only for its rich traditions in patient care and orthopaedic rehabilitation, but also for its research and training programs. In the clinics I was exposed to a spectrum of shoulder and elbow problems, and had the opportunity to examine many patients with impressive long-term results of shoulder and elbow arthroplasty. In India, 4 to 6 joint replacements in a single patient are rare, and hence, I was often taken aback on meeting patients with replacements of both shoulders, elbows, hips, knees, and ankles! The clinics also gave me an opportunity to observe and learn the effective and judicious use of diagnostic ultrasonography of the shoulder. I had the opportunity to assist Mr. Carr in numerous surgical procedures. These included shoulder arthros-
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 981–984
981
982
D. N. PARDIWALA
copy, elbow arthroscopy, primary and revision shoulder arthroplasty, primary and revision elbow arthroplasty, as well as other open surgical procedures. I was particularly impressed with the effortless finesse with which Mr. Carr performed open Bankart repair with capsular shift for shoulder instability, and eagerly accepted the many ‘tips and tricks’ he offered. It was also my first exposure to elbow arthroscopy and Mr. Carr clearly demonstrated its role and effectiveness. During my 5 weeks at Nuffield Orthopaedic Centre I was fortunate to work with other surgeons too. I assisted Mr. Christopher Dodd of the Knee Service in numerous arthroscopic ACL reconstructions, besides other knee arthroscopic surgeries. Being accustomed to using autograft patellar tendon for ACL reconstructions, I was mildly surprised to learn that all the surgeons at this institute preferred the quadrupled hamstring tendon as their autograft of choice. At Nuffield I was also exposed to the world of unicondylar knee replacements, which although new to me, had been performed at this institute for many years. Although the surgical technique appeared demanding and quite unforgiving if performed inaccurately, I was impressed with many of the excellent results I saw. I also spent a few days working with Mr. Paul Cook, the Ankle and Foot specialist at Nuffield, and was amazed at the volume of ankle arthroscopy that was referred to him. My exposure to ankle arthroscopy was limited and assisting him was a great learning experience. The ankle arthroscopic procedures I learned included excision of bony impingement, debridement of soft-tissue impingement, loose body removal, treatment of osteochondritis dissecans, and ankle arthrodesis. Wrist arthroscopy too was new to me, and I was fortunate to observe a few diagnostic and therapeutic wrist arthroscopic procedures being performed by Mr. Peter Burge.
Hospital, was a revelation. I had first-hand exposure to diagnostic and therapeutic hip arthroscopy and managed to assimilate many of the finer technical details that make the procedure less daunting. The cases in which I saw remarkable relief of symptoms included resection/debridement of inverted labral tears with impingement, removal of loose bodies and osteochondral fragments, and debridement and lavage of early osteoarthritic joints. With Mr. Villar, I was also exposed to hip resurfacing arthroplasty, which seems to be having a surge in popularity at some centers in the United Kingdom and the United States. My short stint with Mr. Villar was enriching not only because of the hip arthroscopy, but also because of the many small tips on managing hip disorders that I picked up from him during clinics and ward rounds. While in Cambridge I had the distinct privilege of working with Mr. David Dandy for a day. It was Mr. Dandy’s well-illustrated book Arthroscopic Management of the Knee that had first got me interested in the subspecialty during my residency, and this occasion was therefore special for me. Besides assisting him in surgery, we had a lengthy discussion on the management of patellofemoral instability and his personal philosophy on ACL reconstruction. I was amazed to learn that even today he rarely if ever uses motorized instruments during arthroscopic procedures. During my academic travels in the United Kingdom, I was invited to visit the Museum of Anatomy and Surgery at the Royal College of Surgeons in Edinburgh. Recounting the rich historical beginnings of medicine as a whole, and the development of surgery and orthopaedics over the ages, the museum has a collection of some of the finest original anatomical dissections and pathological specimens. It was an unforgettable experience.
Addenbrookes Hospital and Cambridge Lea Hospital, Cambridge, England
Hospital for Special Surgery, New York City
Although I had been performing knee, shoulder, and ankle arthroscopy prior to commencing my fellowship, the intriguing world of hip arthroscopy had eluded me. I often wondered if it was technically feasible to negotiate an arthroscope within the hip joint, and if so, what therapeutic benefits it could achieve. The next surgeon I visited convincingly dispelled any doubts I had of the procedure and its role in sports medicine today. Working with Mr. Richard Villar for a month at Addenbrookes Hospital, Cambridge, and the Hip and Knee Unit, Cambridge Lea
The Hospital for Special Surgery in New York City has been at the forefront of sports orthopaedics for many years and here it was an honor to be associated with some of the greats of the field. Dr. Russell Warren, with whom I was primarily associated, taught me his methodical approach to shoulder and knee arthroscopy and, in assisting him with these procedures, I gained through his years of experience. In addition to the entire gamut of sports-related knee and shoulder problems, I was exposed to many procedures new to me. These included the use of osteochondral allografts for chondral defects of the knee, autogenous
TRAVELING FELLOWSHIP REPORT chondrocyte implantation, revision ACL reconstruction, the use of tendon allografts for multiligament knee reconstructions, and thermal capsular shrinkage for shoulder instability. From him I also gained a deeper understanding of meniscal repair and the various means to achieve this. My six weeks at the Hospital for Special Surgery gave me an ample opportunity to learn from the many experts there. Dr. Edward Craig taught me the finer aspects of arthroscopic subacromial decompression and mini-open rotator cuff repair. From Dr. David Altchek I learned the importance of precise methodology and standardization of technique, be it for ACL reconstruction or arthroscopic shoulder stabilization. He also taught me his technique for ulnar collateral ligament reconstruction of the elbow. Beside demonstrating his transverse incision for ACL reconstructions, Dr. Thomas Wickiewicz offered numerous tips on meniscal repair techniques. From Dr. Frank Cordasco I learned the art of performing routine procedures precisely and effortlessly. He also taught me arthroscopic shoulder stabilization using suture anchors, repair of SLAP lesions, and arthroscopic rotator cuff repair. I also had the opportunity to observe Dr. Andrew Weiland performing wrist arthroscopy and arthroscopic carpal tunnel release, Dr. Martin O’Malley performing arthroscopy of the ankle and subtalar joints, and Dr. Robert Buly performing hip arthroscopy. In addition to learning a significant amount from the ongoing discussions in the operating room and clinics, I gained a great deal of knowledge from the morning conferences and academic programs. These included not only sessions on the basic sciences and sports radiology, but also extremely interesting seminars on revision ACL reconstruction, reconstructive techniques for chondral defects, and the management of failed extra-articular open shoulder stabilization. I also appreciated the enthusiasm of the extremely knowledgeable operating room staff, especially “Tommy,” Stash, and Willie, who introduced me to the technical details of the newest instrumentation for arthroscopic rotator cuff repair, meniscal repair, and osteochondral allograft transplantation. The American Sports Medicine Institute and the Alabama Sports Medicine & Orthopaedic Center, Birmingham, Alabama The last month of my fellowship was spent at the American Sports Medicine Institute. My experience here included not only the clinical and surgical
983
aspects of orthopaedic injuries in sports, but also an overall exposure to primary health care in sports medicine, sports medicine research, and sports rehabilitation. The guided tour of the Institute that Mr. Dale Baker gave me on my arrival convinced me that this was a comprehensive and integrated sports institute like none other I had ever seen. The facility included extensive and elaborate clinics and operating rooms, a high-tech sports rehabilitation center, research labs, and a motion analysis lab for studying sports actions. With Dr. James Andrews, I had the opportunity of learning the arthroscopic and open treatment of the entire range of shoulder and elbow problems in throwing athletes. This included a spectrum of unstable shoulders treated arthroscopically or with open capsulolabral repair, revision shoulder stabilization procedures, a vast number of arthroscopic elbow procedures, and ulnar collateral ligament reconstruction of the elbow. My stint with him also exposed me to his techniques for pediatric ACL reconstruction, open repair for posteromedial meniscocapsular disinsertion, the all-inside repair of meniscal injuries using bioabsorbable meniscal screws, and arthroscopic fixation of osteochondral fragments. I also had the opportunity of working with Dr. William Clancy, and learned his “anatomic ACL reconstruction,” 2-bundle PCL reconstruction, revision ACL reconstruction with contralateral patellar tendon, and pediatric ACL reconstruction. A large number of sports conferences and interactive teaching sessions were held during my stay at the American Sports Medicine Institute. These included ACL injuries in immature athletes, revision ACL reconstruction, meniscal repair, multiligament knee reconstruction, arthroscopic subacromial decompression, peak performance in golf, and the biomechanics of throwing. Working at the American Sports Medicine Institute was an excellent experience. This was due in part to the interesting primary and revision sportsrelated cases I was involved with in the clinics and the operating room, but also because I was exposed to an integrated approach to sports injuries that included an active participation in the postoperative rehabilitation of athletes. I also had the opportunity to accompany the orthopaedic sports medicine fellows to high school and college football games and involve myself in the primary care of injuries on the playing field.
984
D. N. PARDIWALA
My Goals My educational goals for this fellowship included: 1. To learn the recent advances in operative arthroscopy of the knee, especially with regard to: ● Arthroscopic PCL reconstruction ● Posterolateral corner and multiple ligament reconstructions ● The treatment of chondral defects using autologous chondrocyte implantation and osteochondral allograft techniques ● The use of meniscal allografts 2. To improve my skills in shoulder arthroscopy and learn new techniques, especially with regard to: ● Arthroscopic management of shoulder instability ● Arthroscopic rotator cuff repair ● Arthroscopic SLAP lesion repair ● Thermal capsular shrinkage 3. To learn the current concepts in operative ankle arthroscopy, particularly post-traumatic chondral and osteochondral lesions. 4. To gain an exposure to and learn the techniques of arthroscopy of the hip, elbow, and wrist and to observe its application and results. The Arthroscopy Traveling Fellowship enabled me to achieve all these goals, and much more. I learned recent advances and new techniques, had an opportunity to interact with the masters in the field, shared discussions with orthopaedic surgeons from other backgrounds, and most importantly, made friends for
life. These included not only the numerous surgeons I worked with and learned from, but also the many visiting orthopaedic surgeons of various nationalities whom I met during my travels. Although the Arthroscopy Traveling Fellowship was an enriching experience for me as an individual, the benefits of this educational exposure will be apparent more widely. The knowledge and skills that I have acquired are being disseminated to many more arthroscopists, orthopaedic surgeons, and residents-intraining via teaching programs and workshops. Moreover, my fellowship experience is making a difference to those to whom it matters most: the athletes and other patients. The results are evident; the sports medicine service at my university hospital is already experiencing a spiraling trend in the number and range of arthroscopic procedures being performed. A concerted effort to spread the techniques, knowledge, and expertise to other hospitals and to nonurban areas is also taking shape. A lack of appropriate training opportunities had resulted in arthroscopy being a neglected subspecialty in India for a long time. The fellowship experience that I have gained is empowering me to change this scenario and enhance the specialty locally. The old order finally changeth. In his Presidential Speech presented at the 16th Annual Meeting of the Arthroscopy Association of North America, Dr. Joe Tippett proclaimed, “AANA does not let anything stand in the way of the education of its members and nonmembers alike. In the last 10 years our primary concern has been to educate . . .” AANA has lived up to its goals and promises. Thank you for this unique opportunity!