December 2000 Bulletin

Shoulder skills course spans Atlantic

OLC course teaches 18 Greek orthopaedists here, others in Greece

Rick Ryu, MD, assists Brian Cole, MD, in a live surgical demonstration of shoulder arthroscopy in the Orthopaedic Learning Center

A long-awaited six-day "traveling, working" trip to the United States by a group of 18 Greek orthopaedic surgeons went off without a hitch in mid-October. The trip had been in the works for three years, since Vassilis Tsemanis, MD, president of the Hellenic Association of Orthopaedic Surgeons and Traumatology (EEXOT), visited the Academy and was impressed by its facilities—especially the Orthopaedic Learning Center (OLC).

The experience inspired Dr. Tsemanis to try to put together a course in the United States for Greek participants. Not only would this give Greek participants the advantage of working with more experienced instructors, Dr. Tsemanis said, but "it would be easier and less expensive for the instructors to attend."

After more than two years of discussions between the Academy and the EEXOT, it was determined that the trip would include not only a shoulder and knee arthroscopy course in the OLC, but would be preceded by observerships at various institutions across the United States.

"This is an expensive affair, so instead of only spending one or two days at the Academy," Dr. Tsemanis said, "the plan was also to spend two or three days in an institution or hospital elsewhere in the United States. Then we would spend a day or two for a particular course at the OLC, and also allow time for the doctors to visit the Academy and its facilities properly. Many of my Greek colleagues have come to America to attend the AAOS annual meetings, but they really don’t understand what the Academy is all about."

The official AAOS/EEXOT program began on Thursday Oct. 19 with a formal tour of the Academy offices and facilities and a welcome reception, and the course took place on Friday. The trip was capped off by visits to three Chicago hospital orthopaedic departments on Saturday.

The groundbreaking aspect of the course was the first live video transmission of the shoulder portion of the course via ISDN lines from the OLC to a site in Greece. The communication was two way and went off without a hitch.


"It was my idea to transmit the course to at least one spot in Greece, and in the future more than one, so other people across the Atlantic can listen to what we have to say, " Dr. Tsemanis said. "There was a group of 20 doctors in my own hospital, watching and listening to what we were doing. We could see them and they could see us—it was excellent. The other idea was to videotape the whole process and produce a two-hour tape of our work, and distribute these tapes to 52 orthopaedic departments in the Greek countryside. So, many benefits will be derived from this trip."

For their observerships prior to the course, the participants were split into several small groups. "They went to various places such as Columbus, Ga., and Pittsburgh, Pa., and really enjoyed themselves," Dr. Tsemanis said. "They love this personal contact—the human touch made a difference to them."

James Tasto, MD, 1999 president of the Arthroscopy Association of North America (AANA), was co-chair of the OLC shoulder and knee arthroscopy course, along with Dr. Tsemanis. "We obtained a nationally and internationally recognized faculty for this course," Dr. Tasto said.

During his welcoming announcements at the beginning of the course, Dr. Tasto gave an overview of the history of the AANA and its services, as well as background leading up to the development of the OLC. He also gave an overview of arthroscopy and a hint at the future development of the specialty.

Following Dr. Tasto, Dr. Tsemanis discussed the Hellenic arthroscopy experience. He informed the group that there are 1,500 orthopaedic surgeons in Greece, with approximately 100 new orthopaedists entering the profession each year. Minimally invasive surgery—arthroscopy—was introduced in Greece in 1979, and is widely used today. With access to the latest books and the Internet, he said, Greek doctors have a working knowledge of the current literature about the latest procedures, and also have the latest equipment.

W. Dillworth Cannon, Jr., MD, member of the skills course faculty, discusses program with Vasillis Tsemanis, MD, president of the Hellenic Association of Orthopaedic Surgeons and Traumatology

The live surgical demonstrations transmitted to Greece were shoulder arthroscopy, arthroscopic subacromial decompression and AC joint resection, labral and Bankart repair and rotator cuff repair.

The 2-to-1 ratio between participants and instructors was critical to the success of the course, according to Dr. Tsemanis. "This is the ideal situation in a skills lab; this ratio is probably the best in the world."

In the morning, before the transmission to Greece, the course included lectures on diagnostic shoulder arthroscopy: anatomy and portal placement; arthroscopic subacromial decompression and AC joint resection; and open rotator cuff repair/mini open rotator cuff repair: indications and techniques. The afternoon session, following the transmission, included ACL hamstring graft harvest; ACL reconstruction utilizing hamstrings, ACL revision utilizing central quadriceps tendon over the top and ACL reconstruction utilizing hamstrings: lab cadaver demonstration. Also, the hands-on skills lab on knot tying was "especially well-received," Dr. Tsemanis said.

All of the doctors that made the trip are between the ages of 35 and 45, Dr. Tsemanis said, "and for half of them, this is the first time they’ve crossed over to the United States. They’ll be excellent ambassadors on the success of the course when they return to Greece."

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