On the faculty in Adelaide
Dr Kenneth Cutbush was on the faculty of the Australian Orthopaedic Association Continuing Orthopaedic Education Meeting in Adelaide in July 2014, which was a well-attended meeting.
What a Continuing Orthopaedic Education meeting is
The Australian Orthopaedic Association is the professional body for orthopaedic surgeons in Australia. It oversees orthopaedic training here and runs the continuing education programme surgeons use to keep their practice current after training. At these meetings faculty members present techniques, review the evidence and take questions from the floor. Being on the faculty means delivering that teaching rather than attending as a delegate.
Arthroscopic AC joint reconstruction
The first lecture covered arthroscopic acromioclavicular joint reconstruction for both acute and chronic injuries.
The acromioclavicular joint is the small joint at the top of the shoulder where the outer end of the collarbone meets the shoulder blade. It is held in position by its own capsule and by the coracoclavicular ligaments beneath. A fall onto the point of the shoulder can tear those restraints, after which the collarbone can shift and the joint becomes painful. Reconstruction aims to restore them, and an arthroscopic technique does that work through small portals using a camera.
Reconstructing the AC joint capsule in addition to the coracoclavicular ligaments adds strength to an arthroscopic repair, particularly against front-to-back movement of the collarbone. Biomechanical testing supports the principle; published series report the clinical results, and individual results vary. The technique for acute injuries has performed well in the series to date.
The arthroscopic Latarjet
The second lecture covered the arthroscopic Latarjet procedure, with both anterior and posterior bone blocks. Initial results for the posterior bone block technique were encouraging, although the numbers at that stage were small.
The Latarjet is a stabilising operation for a shoulder that dislocates repeatedly. A small piece of bone called the coracoid process is moved, with its attached tendon, to the rim of the shoulder socket, which deepens the socket and adds a restraining sling as the arm is raised. It is generally considered where the rim has been worn or broken away, so that repairing the soft tissue alone would leave too little bone to keep the joint in place. A bone block placed at the back of the socket addresses instability in the opposite direction. Individual results vary.