Mary Lloyd Ireland MD – Professor
www.marylloydireland.com
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Through the Arthroscope and Camera: 35 Years of Practice
October 16, 2019
33rd Annual Grice Day Boston, MA
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Menu
0:50
Shriner’s Parade Boston 1984 Fellowship
1:32
Mentors
2:30
Lyle J. Micheli, MD
2:50
-Encyclopedia of Sports Medicine
-The Adolescent Athlete: A Practical Approach
-The Pediatric and Adolescent Knee
-The Sports Medicine Bible for Young Athletes
-Numerous issues of Clinics in Sports Medicine
4:56
1984 Triathlons became popular. Survey?
5:55
Boston Ballet
7:05
Calcaneal Apophysitis
Soccer #1 Sport
7:55
Boston Marathon
8:22
View Through the Lens: Reflections
8:44
View from the Sideline
9:32
University of Kentucky Sideline View 1985-1996
10:08
DSLRs to iPhones
10:38
Beginnings of Arthroscopy - East & West
WWII 1939-1945 - Stopped Advances
12:04
Arthroscopes and Shavers 35 Years Ago
12:43
ACL MCL Repair Left Knee
iPhone 11 Pro
13:38
Thomas Edison Kinetograph Patent Kinescope or Peep-Hole Viewer
1891
Auguste and Louis Lumière Cinematograph Patent
1895
First Film Makers
14:24
Soccer
Auguste and Louis Lumière
15:28
Medical Director, WUSASun Wen, FIFA player of the year
Billie Jean King,
15:57
Acrobats
Auguste and Louis Lumière
17:28
ACSM Lyle Micheli MD
18:53
Ben Wilson Presents at ACSM 2016
Boston Children's Fellow
19:17
Rathbone Breakfast 2019
– Past ACSM President
20:06
Bag Race
Auguste and Louis Lumière
21:01
ACL Reconstructions
– 70s to Early 80s:
– Mid-80s to Mid-90s:
- Mid-90s:
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Capsular Ligament Injuries
– Pre-1975:
Capsular repairs, cut out the ACL
– Evolution to reconstruct ACL
– 2000:
Diagnose AMRI and PLRI
– PCL injuries reconstruct if associated with medial or lateral injuries
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Concept of Rotatory Instability, Not Cruciate-Deficient Knee
– Dr. Jack Hughston’s
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extraarticular to intraarticular anatomic reconstruction . . .
20 years Ago Arthroscopic View: Debridement of Arthrofibrosis
25:28
Failed Goretex ACLR
25:58
HTO The Hughston Clinic way 1970-80s
26:33
Prior to 1985
Extraarticular reconstructions
Shoulder
Subscapularis transfer, Coracoid transfer, Capsular shifts
Knee
IT band tendodeses, Pes anserine transfer
Ankle
Peroneus brevis transfers
After 1985
Anatomic repairs/reconstructions
27:23
2 mo. later: arthroscopy
28:13
Knee “pack-years”
29:18
John Feagin
40 years ago
-Repair does not work
Martha Murray MD
2019 BEAR works in humans. 2 year follow up
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Clinical Trials at Boston Children’s
-Suturing enhanced with collagen and platelet rich plasma (PRP)
-Strength similar to that of ACLR at early time points
-Additional testing needed before clinical trial can be considered
30:53
Shoulder Pain in a Thrower Biceps Tendon / Labrum
• Prior to 1980s, biceps tendinitis
• 1990s: SLAP lesion
• 2005: SLAP lesion
Biceps tendon – leave alone, Tenodesis soft tissue, Tenodesis to bone, Tenotomy
32:18
Biceps Glenoid Labrum Complex
– Pre-1985
Tenodesis,
- Now 62 years later:
Biceps is still a pain generator
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2000 Advances in Biceps Treatment?
-Repair no SLAPs over age 40
-Tenodesis open or arthroscopic
-Tenotomy
• SLAP
33:34
Shoulder Instability
Extraarticular techniques
• Tendon transfers
• Coracoid transfer
Intraarticular techniques
• Capsular shifts
• Latarjet procedure
Combined intraarticular/extraarticular
Bankart ASB: Recurrent or habitual dislocation of the shoulder-joint. Br Med J: 2;1132, 1923.
Manual of Sports Surgery, New York, 1987, Springer-Verlag.
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Bristol Procedure-Coracoid Transfer
35:23
Rotator Cuff Repair
- Diagnosis:
– Treatment:
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Beware of New Products
37:24
Charles Dickens
37:43
Hip Pain in Athletes - Groin
– Prior to 1985:
• Most common dx was: Adductor strain
– 1985 to 1990: inguinal hernia
– 1990 to present: athletic pubalgia
• Rectus abdominus insertional
fibrocartilaginous plate injury Adductor longus, brevis avulsion
Differential Diagnosis
38:20
Hip Pain in Athletes – Femoroacetabular Impingement
– Pincer type
• Acetabular side, Labral tear • Smith Peterson
38:56
Foot/Ankle: Posterior impingement and Haglund’s syndrome
- Prone arthroscopy
– Ballet dancers
– Os trigonum excision
- FHL tenosynovectomy
- Haglund syndrome
• Subacromial view of the foot•
39:42
Youth Elbow: Baseball Pitcher
– Little Leaguer’s Elbow
Adams, 1964
40:40
12 YO boy
– Little Leaguer injured while pitching 5 months prior
Case courtesy of Dr. Adam Smith
42:18
BB Bullet Appearance to medial epicondyle fracture
42:48
14 YO Pitcher, medial elbow pain
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Conclusion:13 YO “Big Pitcher” Syndrome
43:42
Be an Advocate
44:48
Advocacy AOSSM
45:52
Seth Leopold MD
46:33
Sports Medicine Clarity Act
47:18
Young athletes:
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https://safesport.org
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www.ue.org
49:58
Take this Test
www.edurisksolutions.org/learn-to-protect-children/
@ukawhi
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Sports Medicine Specialists for Youth
50:58
CHANGE, CONTROL
CHARACTER
Embrace Change
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The End...