Extract
The sources for this article were presentations and symposia at
meetings of the American Orthopaedic Society for Sports Medicine
(Specialty Day, San Francisco, California, March 2001), the Arthroscopy
Association of North America (Specialty Day, San Francisco, California,
March 2001; Twentieth Annual Meeting, Seattle, Washington, April
2001; and Nineteenth Fall Course, Palm Desert, California, November
2000), the American Academy of Orthopaedic Surgeons (Sixty-eighth
Annual Meeting, San Francisco, California, March 2001), and the
American Shoulder and Elbow Surgeons (Specialty Day, San Francisco,
California, March 2001, and Seventeenth Annual Meeting, Austin,
Texas, October 2000).
The sources for this article were presentations and symposia at
meetings of the American Orthopaedic Society for Sports Medicine
(Specialty Day, San Francisco, California, March 2001), the Arthroscopy
Association of North America (Specialty Day, San Francisco, California,
March 2001; Twentieth Annual Meeting, Seattle, Washington, April
2001; and Nineteenth Fall Course, Palm Desert, California, November
2000), the American Academy of Orthopaedic Surgeons (Sixty-eighth
Annual Meeting, San Francisco, California, March 2001), and the
American Shoulder and Elbow Surgeons (Specialty Day, San Francisco,
California, March 2001, and Seventeenth Annual Meeting, Austin,
Texas, October 2000).
Rotator Cuff
Basic Science
Uhthoff presented evidence that, in a rabbit model, the fatty infiltration
that occurs in muscle after a rotator cuff tear is not reversed
by a successful rotator cuff repair. This observation may prompt
surgeons to reconsider rotator cuff repair for patients with this
finding on magnetic resonance imaging. Altchek reported that a subscapularis
tear increases external rotation and posterior translation and that
this effect is not increased by the addition of an anterior capsular
tear.
Impingement
The debate continues regarding the role of acromioplasty during
the operative treatment of rotator cuff tears or impingement. Nirschl
and Matsen advocated avoiding acromioplasty because of potential
destabilization of the glenohumeral joint, harm to the deltoid origin,
loss of the acromial lever, postoperative hemorrhage and adhesion,
increased postoperative pain, and occasional acromial fracture.
Partial-Thickness Tears
Warren found that arthroscopic subacromial decompression was
an effective treatment for partial-thickness tears of the rotator
cuff followed for a mean of fifty-three months. However, the failure
rate for partial-thickness tears of the bursal surface of the rotator
cuff was 38%. This finding may suggest that a more aggressive
approach to tears of the bursal surface is needed.
Full-Thickness Tears
Miniaci arthroscopically repaired mobile full-thickness tears of
the rotator cuff with a bioabsorbable tack and found the procedure
easier to perform than a repair with knot-tying techniques. His
results were equivalent to those of previously reported arthroscopic
repairs. Hawkins found that good results were possible when both
a Bankart lesion and a rotator cuff tear were repaired at the same
operation. Bigliani found superior results when a dislocated or
subluxated biceps tendon was left in situ during the repair of a
full-thickness rotator cuff tear. Relocation and stabilization of
the tendon had the highest percentage of unsatisfactory results.
Savoie found 88% excellent-to-good results with the arthroscopic
treatment of large (3 to 5-cm) rotator cuff tears.
Subscapularis Tears
Burkhart reported successful results with arthroscopic treatment
of complete subscapularis tears. He also studied the subscapularis
attachment footprint and found that the superior portion was the
most substantial.
Acromioclavicular Joint
Zuckerman resected the acromioclavicular joint in cadaver specimens
and found that the direct (superior) technique and the indirect
(bursal) technique were equivalent with regard to the amount of
anterior-posterior distal clavicular stability that they produced.
Weber described his technique for harvesting the coracoacromial
ligament arthroscopically prior to mini-open repair for the treatment
of acromioclavicular joint dislocation. He found that subperiosteal
harvesting of the coracoacromial ligament arthroscopically increased
its available length by 1 cm. In a biomechanical study, Lee found
that the semitendinosus tendon was stronger and stiffer than the
coracoacromial ligament in the treatment of acromioclavicular joint
dislocations.
Biceps
Burkhead performed a laboratory analysis comparing methods of
fixation for biceps tenodesis and found that suture anchors provided
better pullout strength than did the keyhole technique. Boileau
presented the clinical results of arthroscopic biceps tenodesis
with a bioabsorbable interference screw. Gross described biceps
tenosynovectomy through a subacromial approach for the treatment
of biceps inflammation.
Labrum and Instability
Biomechanics
Tibone created a Bankart lesion in a cadaver model. There was
little increase in translation following one dislocation but greater
translation after the second and third dislocations. These laboratory
data support clinical experience.
Multidirectional Instability
Miniaci presented his results with thermal capsulorrhaphy for the
treatment of multidirectional instability; he reported failure in
nine of nineteen patients. The procedure failed in all patients
with a predominant posterior component. Three cases of axillary
neuritis resolved by nine months. Paulos reported that, when thermal
capsulorrhaphy was used alone as a treatment, the failure rate increased
with time, with a rate of approximately 30% at thirty-six
months. These reports diminish the enthusiasm for thermal capsulorrhaphy
when it is used without labrum repair or suture capsular plication.
Lephart reported that proprioception was restored following thermal capsulorrhaphy,
which addressed the concern that thermal treatment of the capsule
may destroy the mechanoreceptors located within it.
Thermal Treatment
Vangsness found that a monopolar energy system achieved shrinkage
23% faster than did a bipolar device. Weber noted the absence
of comparative, prospective, clinical studies of thermocapsular
shrinkage in peer-reviewed journals. He discussed the complications
of recurrence, stiffness, capsular necrosis, and injury of the axillary
nerve. Thermal treatment remains controversial, with good results
reported by some authors and major complications reported by others.
As mentioned, the enthusiasm for thermal treatment alone appears
to be diminishing. Many authors have recommended suture repair of
labral and capsular lesions and use of thermal treatment to augment,
rather than replace, traditional repair techniques.
Traumatic Unidirectional Instability
Williams reported on shoulders with a Bankart lesion that had healed
medially. When examined with the patient under anesthesia, the shoulders
had an 8° loss of passive external rotation compared with the contralateral,
uninjured shoulder. In contrast, passive external rotation of shoulders
with a detached Bankart lesion was 5° greater than that of the uninjured
shoulder. Burkhart emphasized the importance of evaluating anterior
bone loss in patients undergoing glenohumeral reconstruction. He
measured the distance from the central bare spot to the glenoid
rim and found that the bare spot was equidistant from the anterior,
posterior, and inferior margins. Anterior bone-grafting was successful
in patients with substantial bone loss. Welsch found that the success
rate of an arthroscopic Bankart repair was related to the number
of preoperative dislocations. The failure rate was 4% for
operations performed after an initial dislocation, 8% for
those performed after three dislocations, and 34% for those
performed after more than ten dislocations.
SLAP Lesions
Glousman found that none of the commonly performed physical examination
tests were sensitive and specific for type-2 SLAP lesions (superior
portion of the labrum, anterior and posterior). Arthroscopy remains
the gold standard for its diagnosis.
Posterior Instability
Warren reported that twenty-four of twenty-seven patients with
isolated grade 1+ or 2+ posterior instability
did well after an arthroscopic labral repair. Three patients with
3+ translation had a failed repair. Abrams reported that
posterior plication (and the use of suture anchors when there was
labral detachment) combined with anterior anchor repair of the labrum
and/or closure of the rotator cuff interval had a 92% success
rate.
Failed Operations for Instability
Iannotti reported the use of an iliotibial band graft for patients with
capsular deficiency following a failed operation for instability.
The patients had improvement postoperatively but poor function.
Patients who also had subscapularis deficiency were treated with
a pectoralis major transfer, but the lift-off test remained positive.
Kim reported good results after arthroscopic treatment in patients
with a failed Bankart repair.
Stiffness
Speer found that diabetic patients with a frozen shoulder had
a decrease in symptoms after arthroscopic release but full recovery
was unlikely.
Shoulder Arthroplasty
Habermeyer reported that patients treated with total shoulder arthroplasty
with a cementless glenoid component had no evidence of lucency or
loosening at the time of a two-year follow-up. Concerns, however,
were raised about late polyethylene failure with this design, which
has a thin polyethylene component.
Failed Shoulder Arthroplasty
Hasan reviewed the characteristics of 141 consecutive shoulders
presenting to a tertiary referral center after an unsatisfactory
shoulder arthroplasty. Stiffness was the most common mode of failure
of both hemiarthroplasties and total shoulder arthroplasties; it
was identified in >75% of the shoulders. Most
shoulders demonstrated several modes of failure, including glenoid
loosening, component malposition, instability, tuberosity malunion,
and residual glenoid pain. Patients with an unsatisfactory result
of a shoulder arthroplasty, especially those who had undergone a
hemiarthroplasty for the treatment of a fracture, reported very
limited function.
Craig performed a study on the benefits of a new magnetic resonance
imaging technique for evaluation after a failed total shoulder arthroplasty.
In Cofield’s study, nine of eighty-nine second-generation
cemented glenoid components were associated with lucency compared
with twenty-four of eighty-one first-generation designs. Ingrowth
humeral stems were associated with less lucency than were cementless
press-fit designs. Williams found that patients with glenoid loosening
and a failed total shoulder arthroplasty did better after revision
with glenoid reimplantation than they did after removal of the glenoid
component and conversion to a hemiarthroplasty. Dines presented
an option for patients with anterior-superior instability after
shoulder arthroplasty. He used an Achilles tendon allograft anchored
to the coracoid process and passed under the entire surface of the
acromion. Pain was reduced but function was not improved. Seitz
reported that all of eight patients with an infection at the site
of a total shoulder arthroplasty were treated successfully with
exchange and reimplantation. The reimplantation was performed six
months after removal, débridement, and placement of an
antibiotic-impregnated spacer.
Fractures
Weber found that 25% of patients with 10 mm of displacement
of a fracture of the greater tuberosity had a tear of the rotator
cuff. He suggested that 5 mm of displacement is a more reasonable
criterion for operative fixation.
Nerve Lesions
Cummins surveyed major-league starting pitchers and found that
5% had suprascapular neuropathy. Most pitchers with isolated
infraspinatus atrophy can be managed nonoperatively and are able
to compete at the major-league level.
Miscellaneous
Speer placed temperature sensors in the subacromial space and
glenohumeral joint and found that cryotherapy substantially reduced
temperature in both areas. Cryotherapy reduces proteolytic enzyme
activity within the glenohumeral joint and is an effective non-narcotic
modality for pain control. Snyder and Esch reported on their experience
with a computer-aided virtual reality simulator for arthroscopic
surgery. Mierisch used calcium alginate gel as a delivery system
for cells in a rabbit model. Although the gel proved to be an effective
delivery system, the cells were not found to have any beneficial effect
on the healing of cartilage defects.
Instability
Several investigators have reported on the biomechanics of elbow
stability. King found that division of either the medial or the
lateral collateral ligament did not increase elbow instability during
simulated active flexion regardless of forearm rotation. He concluded
that the forearm should be splinted in supination following injury
to the medial collateral ligament and in pronation following injury
to the lateral collateral ligament to prevent increased rotational
instability during passive flexion.
Mullen found that intact cadaver elbows and those that had undergone
reconstruction of the medial collateral ligament had similar stability
to valgus loading at 30°, 60°, and 90° of elbow flexion but not
at 120° of elbow flexion. In a similar study, Klepps compared the
biomechanical properties of elbows treated with the four-strand
docking technique for reconstruction of the medial collateral ligament
with those of intact elbows and those of elbows treated with the
traditional Jobe technique. The native ligament demonstrated greater stiffness
than did either repair construct. In addition, elbows reconstructed
with the docking procedure had a greater maximum moment of failure
and allowed less strain at submaximal loading than did those reconstructed
with the Jobe technique.
Tendon Repairs
Biomechanics
Lemos found that suture-anchor and bone-tunnel fixation for distal
biceps tendon repair resulted in comparable yield strengths in a
cadaver model when other factors such as bone density, tuberosity
area, and repair stiffness were controlled. The pullout strength
performance, however, may not necessarily reflect the cyclic loading
environment during rehabilitation after a biceps tendon repair.
Treatment
Kelly presented the results of repairs of chronic distal biceps tendon
tears with use of an Achilles tendon allograft, a tensor fasciae
latae graft with a ligament augmentation device, or a semitendinosus
autograft. All patients returned to their previous professions,
six obtained full extension, and none lost forearm rotation. Morrey
demonstrated that use of an Achilles tendon allograft is an option
for the augmentation of reconstruction of chronic distal biceps
and triceps tears. The permanent change in the length-tension performance
of a chronically ruptured biceps muscle may adversely affect its power
and excursion. Achilles tendon allograft was also used for soft-tissue
interposition during nonprosthetic ulnohumeral arthroplasty.
Mair used the National Football League database to obtain the largest
series to date of partial or complete distal triceps tendon injuries.
Twelve players with a complete tendon tear underwent immediate surgery
and three players with a partial tear underwent surgery at the end
of the season for the treatment of residual weakness and pain. An
additional six players were treated without surgery and recovered
full strength. No player had postoperative stiffness, one patient
had a retear, and all but one patient returned to play for at least
one more season.
Fractures and Dislocations
Biomechanics
Hage found that insertion of a prosthesis with a metallic radial head
substantially increased stability with the forearm in pronation
and in neutral following radial head resection in a cadaver model.
Elbows with injuries of the medial and lateral collateral ligaments
were not stabilized by the prosthesis in any forearm position.
Treatment
Steinmann presented the results following open reduction and internal
fixation of sixteen comminuted olecranon fractures and fracture-dislocations
with a 3.5-mm dynamic compression plate placed posteriorly on the
ulna and bent around the olecranon tip. At a mean of 3.5 years after
the operation, radiographic union had been achieved in thirteen
patients and nonunion was found in the remaining three. Of the ten patients
with an acute fracture or a persistent nonunion, only one had a
poor result. Of the six patients undergoing additional elbow reconstruction
because of ligament injury and bone loss, three had a poor result.
Karlsson found that, after a mean duration of follow-up of eighteen
years, 81% of elbows with an olecranon fracture treated
with the AO tension band technique had undergone subsequent hardware
removal compared with 43% of elbows treated with a figure-of-eight
wire technique. Overall, 80% of the sixty-seven patients
had no symptoms and 16% had only occasional pain. Curtis
described olecranon stress fractures in eight throwing athletes.
Incomplete stress fractures treated by rest and immobilization healed
by ten weeks. Fractures that did not heal following closed treatment
healed following open reduction and internal fixation.
McKee reviewed the results of treatment of elbow dislocations
associated with radial head and coronoid fractures in a series of
forty consecutive patients. At a mean of eighteen months, the mean
flexion-extension arc was 109° and the mean Mayo Elbow Performance
Score (MEPS) was 88.6 points. The authors concluded that avoiding
isolated radial head excision, repair of substantial coronoid fractures,
selective use of hinged external fixation, and early recovery of motion
led to better results than those in previous reports on the treatment
of this "terrible triad."
Frankle found primary total elbow arthroplasty to be an effective
treatment for distal humeral fractures in older patients. Patients
with hardware failure, malunion, and arthritis following internal
fixation were compared with those who had undergone primary arthroplasty.
At a mean of 3.5 years postoperatively, the American Shoulder and
Elbow Surgeons (ASES) score averaged 92 points, the MEPS score averaged 95.8
points, and the flexion-extension arc averaged 120° in the primary
arthroplasty group compared with 77 points, 73.4 points, and 75°,
respectively, in the revision group. Patients who had had a primary
arthroplasty performed twelve of fifteen activities of daily living
compared with only seven activities in the revision group.
Arthritis
Nonprosthetic Arthroplasty
Nonprosthetic options for the treatment of primary degenerative
arthritis of the elbow continue to be explored. Antuna described
the experience at the Mayo Clinic with fifty-five elbows treated
over a ten-year period. The surgery consisted of fenestration of
the olecranon, removal of loose bodies, and excision of olecranon
and coronoid osteophytes. A capsular release was performed in nineteen
elbows, and an ulnar nerve transposition or neurolysis was done
in eight. At the time of follow-up, patients demonstrated major
pain relief and improvement in the MEPS score. Elbow flexion and
extension increased modestly (by 10°) but significantly (p < 0.05). According
to the patients’ self-assessments, 24% of the elbows
did not improve, mainly because of residual ulnar nerve symptoms.
Nonprosthetic arthroplasty with use of soft-tissue interposition
is also being performed in young patients with elbow arthritis,
but its conversion to prosthetic arthroplasty has not been reported
previously. Blaine studied the results in thirteen patients who
had had conversion of an interposition arthroplasty to a semiconstrained
total elbow arthroplasty because of severe pain and/or
instability; the mean interval until the conversion was twelve years.
After a mean duration of follow-up of nine years, the mean MEPS
score had improved from 34 to 84 points, pain was absent or mild
in eleven patients, and a satisfactory result had been achieved
in eleven elbows.
Prosthetic Arthroplasty
Wiater compared the results in twelve patients who had undergone
simultaneous bilateral total elbow arthroplasty for the treatment
of advanced rheumatoid arthritis with those in twelve patients who
had undergone staged bilateral total elbow arthroplasty with eight
months or less between the procedures. No differences between the
two treatment groups in terms of complications, duration of hospital
stay, or operative time were noted. At a mean of four years postoperatively,
all patients who had undergone simultaneous bilateral arthroplasty
were satisfied with the result and all of their elbows were rated
as good or excellent. Cost analysis showed simultaneous bilateral
total elbow arthroplasty to be a cost-effective treatment strategy
for patients with advanced bilateral elbow arthritis.
Ring concluded that an unstable capitellocondylar (nonconstrained)
total elbow replacement should be revised to a semiconstrained arthroplasty.
The humerus and ulna are often perforated during revision, but on
the average a functional flexion-extension arc is restored. Loebenberg
reported the results of impaction grafting after total elbow arthroplasties that
had failed because of severe osteolysis. Isolated impaction grafting
was performed in the ulna in four extremities, in the humerus in
six, and in both in two. Despite multiple previous revisions in
most cases, at the time of a minimum two-year follow-up ten elbows
remained intact, one elbow had been revised for loosening, and one
had undergone resection arthroplasty because of infection. The ten
intact elbows demonstrated marked radiographic improvement in bone
quality without clinical symptoms of loosening.
Arthroscopy
Synovectomy
Horiuchi noted that patients with rheumatoid arthritis typically
had temporary improvement following arthroscopic elbow synovectomy.
The mean MEPS score improved from 48 points preoperatively to 78
points at two years postoperatively, but it decreased to 69 points
at the time of the eight-year follow-up. Clinically relevant synovitis
recurred in five of twenty-one elbows, and it required total elbow
arthroplasty in two of them. The most recent follow-up radiographs
demonstrated additional degenerative changes in seventeen elbows.
Release
Meunier evaluated the outcomes following circumferential arthroscopic
elbow release for carefully selected patients with post-traumatic
contracture. Preoperative flexion and extension deficits decreased
20° and 30°, respectively, and there were no neurovascular complications.
Other expert elbow arthroscopists pointed out that ulnar nerve transection
has occurred with this type of treatment.
Complications
Reports on complications of elbow arthroscopy underscore the
fact that the risk associated with this procedure is greater than
that associated with arthroscopy of other joints and elbow arthroscopy
should not be performed by surgeons who perform arthroscopy only
occasionally. Kelly performed a retrospective review of complications
following elbow arthroscopy during an eighteen-year period. Of 473
consecutive arthroscopic procedures, four (0.8%) were associated
with a serious complication such as a joint space infection and
fifty (11%) were associated with a minor complication such
as prolonged drainage or superficial infection. There were seven persistent
minor contractures and twelve temporary nerve palsies. An underlying
diagnosis of rheumatoid arthritis and an elbow contracture were
the strongest risk factors for a neurapraxia. There were no permanent
neurovascular injuries, hematomas, or compartment syndromes.
O’Driscoll presented his extensive experience identifying nerves
during such arthroscopic procedures as capsulectomy and soft-tissue
arthroplasty. Arthroscopic synovectomy and capsulotomy with motorized
instruments are performed until the instrument is near the nerve,
at which point the capsule is bluntly dissected to expose the nerve.
The remainder of the procedure, including additional soft-tissue
and bone resection, is then performed with the nerve in direct view
to minimize the potential for injury.
Miscellaneous
Leith presented a new standardized self-assessment instrument
for evaluation of elbow function. Scores ranged from three of twelve
functions for patients with inflammatory arthritis to eleven functions
for patients with medial epicondylitis. Only seven of 104 patients
could perform all twelve functions. The score improved from three
to nine functions following total elbow arthroplasty.
Shoulder
Adhesive Capsulitis
Griggs SM, Ahn A, Green A.Idiopathic adhesive capsulitis.
A prospective functional outcome study of nonoperative treatment. J
Bone Joint Surg Am. 2000;82:1398-407.
Arthroplasty
Boileau P, Trojani C, Walch G, Krishnan SG, Romeo A, Sinnerton
R. Shoulder arthroplasty for the treatment of the sequelae
of fractures of the proximal humerusJ Shoulder Elbow Surg. 2001;10:299-308.
Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE
3rd. Biomechanical effects of malposition of tuberosity fragments on
the humeral prosthetic reconstruction for four-part proximal humerus
fractures. J Shoulder Elbow Surg. 2001;10:321-6.
Goldberg BA, Smith K, Jackins S, Campbell B, Matsen FA 3rd. The
magnitude and durability of functional improvement after total shoulder
arthroplasty for degenerative joint disease. J Shoulder
Elbow Surg. 2001;10:464-9
Instability
Gartsman GM, Roddey TS, Hammerman SM. Arthroscopic
treatment of bidirectional glenohumeral instability: two- to five-year
follow-up. J Shoulder Elbow Surg. 2001;10:28-36.
Greis PE, Burks RT, Schickendantz MS, Sandmeier R. Axillary
nerve injury after thermal capsular shrinkage of the shoulder. J
Shoulder Elbow Surg. 2001;10:231-5.
Lee TQ, Black AD, Tibone JE, McMahon PJ. Release
of the coracoacromial ligament can lead to glenohumeral laxity:
a biomechanical study. J Shoulder Elbow Surg. 2001;10:68-72.
Misamore GW, Facibene WA. Posterior capsulorrhaphy
for the treatment of traumatic recurrent posterior subluxations
of the shoulder in athletes. J Shoulder Elbow Surg. 2000;9:403-8.
Tibone JE, Lee TQ, Black AD, Sandusky MD, McMahon PJ. Glenohumeral
translation after arthroscopic thermal capsuloplasty with a radiofrequency
probe. J Shoulder Elbow Surg. 2000;9:514-8.
Rotator Cuff
Galatz LM, Griggs S, Cameron BD, Iannotti JP. Prospective
longitudinal analysis of postoperative shoulder function: a ten-year
follow-up study of full-thickness rotator cuff tears. J
Bone Joint Surg Am. 2001;83:1052-6.
Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results
of biceps tenotomy for treatment of pathology of the long head of
the biceps brachii. J Shoulder Elbow Surg. 2001;10:247-9.
Grondel RJ, Savoie FH 3rd, Field LD. Rotator cuff
repairs in patients 62 years of age or older. J Shoulder
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Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton
WD. Natural history of asymptomatic rotator cuff tears: a
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Shoulder Elbow Surg. 2001;10:199-203.
Elbow
Biomechanics
Closkey RF, Goode JR, Kirschenbaum D, Cody RP. The
role of the coronoid process in elbow stability. A biomechanical
analysis of axial loading. J Bone Joint Surg Am. 2000;82:1749-53.
Dunning CE, Zarzour ZD, Patterson SD, Johnson JA, King GJ. Muscle
forces and pronation stabilize the lateral ligament deficient elbow. Clin
Orthop. 2001;388:118-24.
Arthroplasty
Gambirasio R, Riand N, Stern R,Hoffmeyer P. Total
elbow replacement for complex fractures of the distal humerus. An
option for the elderly patient. J Bone Joint Surg Br. 2001;83;974-8.
Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King
GJ. Functional outcome of semiconstrained total elbow arthroplasty.
J Bone Joint Surg Am. 2000;82:1379-86.
Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ. Arthroplasty
with a metal radial head for unreconstructible fractures of the
radial head. J Bone Joint Surg Am. 2001;83:1201-11.
Arthroscopy
Kelly EW, Morrey BF, O’Driscoll SW. Complications
of elbow arthroscopy. J Bone Joint Surg Am. 2001;83:25-34.
Baker CL Jr, Murphy KP, Gottlob CA, Curd DT. Arthroscopic
classification and treatment of lateral epicondylitis: two-year
clinical results. J Shoulder Elbow Surg. 2000;9:475-82.
Third Biennial Shoulder and Elbow Meeting. Jointly sponsored
with the American Shoulder and Elbow Surgeons. Course #3404.
2002 Apr 4-7; Orlando, FL. Chairmen: Louis U. Bigliani, MD, John
M. Fenlin Jr., MD, Evan L. Flatow, MD, Tom R. Norris, MD, and Jon
J.P. Warner, MD.
The Shoulder: Current Practice in Open and Arthroscopic Techniques.
Course #3409. 2002 May 3-5; Rosemont, IL. Chairmen: Peter
D. McCann, MD, and Anthony Miniaci, MD.San Diego Shoulder Arthroscopy
Nineteenth Annual Meeting: Arthroplasty and Fractures. 2002 Jun
19-22; La Jolla, CA. Chairman: James C. Esch, MD. www.shoulder.com
Advanced Arthroscopic and Open Shoulder Surgery. Course #3414.
2002 Jul 19-21; Rosemont, IL. Chairmen: George M. McCluskey III,
MD, and Gordon Nuber, MD.
Shoulder Surgery Controversies. 2002 Oct 4-6; Costa Mesa, CA.
Chairman: Wes Nottage, MD.
Elbow Arthroscopy, Fractures, Instability and Stiffness. Course #3430.
2002 Dec 6-7; Rosemont, IL. Chairmen: Shawn W. O’Driscoll,
MD, and Ken Yamaguchi, MD.
Ninth International Congress on Surgery of the Shoulder Meeting.
2004 May 2-5; Washington, DC.