President's Message - March 201303.05.2013
Rotator Cuff Guidelines was released from the Academy and has generated a large debate on whether the literature supports or refutes the current management options. Although this was designed to critique available level of evidence and possibly stimulate new Level I studies, there was great concern on how this would affect public opinion, reimbursement, and patient management. Early treatment in select cases may be delayed by indecisiveness, and both operative and nonoperative management have been challenged. ASES and individuals from other organizations have made a loud rebuttal to the reported findings and have suggested that expert opinion should not be excluded from the decision process, since the majority of the peer-reviewed shoulder literature is either level of IV or V.
The appropriate use criteria or AUC is the next step in the process. The purpose here is to try to blend all of the available information including expert opinions. The ASES Executive Committee has submitted a list of members that would be involved in the review panel and writing panel. The review panel will be responsible for evaluating the available literature, not only Level I or II, and creating appropriate recommendations. It will be comprised of ASES members, AANA, AAOS, AOSSM, and other practicing shoulder practitioners. The voting panel is a selected group that will meet in Rosemont to critique and fine tune the AUC. The selected individuals for this step have further requirements and restrictions regarding conflicts of interest. The final product is still an unknown, but we are hopeful that it is more “user friendly,” less controversial, and unites most physicians who manage patients with shoulder disorders.
As we turn the corner and enter 2013, preparation for the AAOS Annual Meeting begins to fill our calendars. The ASES Specialty Day is an exciting, dynamic event under the direction of Brian Cole, M.D., and Peter Millett, M.D. The paper selection was extremely competitive, and the Open Meeting Committee should be congratulated on their selection and design for this year’s meeting on March 23, 2013 in Chicago. Many of the sessions on shoulder or elbow topics will be supported with case-based presentations. Symposium on managing the failed shoulder stabilization, the massive cuff tear, troubling elbow fractures, and the overhead athlete will generate lively debate. How-to videos on soft tissue reconstruction for elbow, reverse shoulder and elbow arthroplasty, and subscapular tenotomy options will be featured. The meeting mixes practical useful information with expertise that will be valuable to all members and those interested in treating patients with shoulder and elbow pathology.
Our Society has discussed collaboration with Dartmouth on shoulder prostheses retrieval data. As some may know, the lower extremity prostheses have been analyzed to learn about wear pattern, reason for mechanical failure, materials, etc. Ultimately, this leads to an improved product. A similar approach to removal of shoulder prosthesis has been proposed, and arrangements for this collaboration are underway. The Dartmouth lab is equipped with state-of-the art technique to add to our current understanding of arthroplasty design and will hopefully lead to making modifications, if appropriate.
The International Congress of Shoulder and Elbow Surgeons will meet in Nagoya, Japan, April 10-12, 2013. The ASES will deliver a large delegation to participate in this year’s meeting. The meeting rotates every three years and brings the international community together to synthesize “world” opinion on important topics in shoulder and elbow surgery. Many of our members will serve as faculty and on the Board of Directors for this important event. Drs. Eiji Itoi and Kenji Takagishi, members of ASES, are serving as the Congress Presidents for this year’s meeting. This meeting will combine advanced topics including papers, symposium, featured lectures, with a view of the Japanese culture and lifestyle. Let us support our international community of educators and enjoy this special meeting.
I look forward to seeing you at these important meetings in the near future. My wishes to all of you for a Happy and Healthy New Year.
Jeffrey S. Abrams, M.D