Winter 2001 Newsletter

Progress. In a word, that is what we believe the discipline of arthroscopy represents. But there is a vast orthopaedic world outside the realm of arthroscopy, and the surgeons that populate that world have often been slow to embrace arthroscopic techniques, particularly those that infringe upon their "territory."

Earlier this month, I had the unique opportunity to participate in a debate on the program of the Closed Meeting of the American Shoulder and Elbow Surgeons, an organization to which I belong. The topic of the debate was whether rotator cuff repair should be performed by arthroscopic or open means. The theme of my argument for arthroscopic repair was that arthroscopy represented progress and that progress was inevitable. In order to avoid being misinterpreted, I emphasized that the arthroscopic approach did not forsake the principles of Codman and Neer, but rather built upon those principles to provide an improved method of treatment for rotator cuff tears. Needless to say, this argument was a "hard sell" to that particular audience, which was composed primarily of the most prominent open shoulder surgeons in the United States. At the conclusion of the debate, the moderator, Dr. Rich Hawkins, took a vote of the audience and, as expected, the vast majority voted that they believed rotator cuff repair should be done by open means. However, Dr. Hawkins then asked the audience how many of them had attempted arthroscopic cuff repairs and believed that the future of rotator cuff repair would lie with arthroscopic techniques; approximately two-thirds of the audience raised their hands. My initial reaction was that the vote had been somewhat schizophrenic. This group of prominent open shoulder surgeons wanted to suppress arthroscopic cuff repair (one must assume to protect their "turf"), yet they were beginning to experiment with it because they recognized it would inevitably replace open repair.

The nature of progress is that it is relentless and always prevails. Progress is always the clear winner. Yet progress can be both threatening and empowering. It threatens those who attempt to suppress it and empowers those who embrace it as well as those who benefit from it. If arthroscopic rotator cuff repair truly benefits patients, then patients will demand it. As demand increases, the entire profession will ultimately recognize this technique for what it is and what it represents ... progress.