I have been taught the science and art of Trauma and Orthopedic Surgery by a great many orthopedists of their time, forward thinkers, real innovators, and technically superb surgeons. My two great mentors, Mr John Fixsen, MChir, FRCS, now sadly deceased,1 and Prof. John B King, FRCS, FFSEM, had 2 things in common, in addition to their first names: they taught me that one should learn concepts, not techniques. Techniques have the bad habit of becoming obsolete overnight. Concepts remain, and allow us to progress. This is what I try and communicate to my trainees, though I must confess that at times it appears that I am fighting a losing battle: the requirements of modern health care and the pressures we are subjected to seem to favor a purely technical approach to our specialty.
The arthroscope is but a tool. It has revolutionized the way we manage many conditions and, to some extent, allows us to undertake ultimate minimally invasive surgery. Talking about technical revolutions, think about how, overnight, some techniques became “old,” though beware of forgetting them altogether: when everything fails, we need to be able to revert to good old open surgery. In this respect, we are in the midst of a further technical revolution, mediated by the use of the arthroscope as an endoscope, but fueled by the needs of our patients, and the imagination, and superb technical skills, of some of us. In this respect, this issue of Sports Medicine and Arthroscopy Review should open our minds and widen our horizons. An arthroscope can be used not just to penetrate an articular cavity: it has been done before, and just about any and all joints in the body have been arthroscoped. It can be used to study soft tissues, producing a working space or exploiting spaces present between various anatomic structures to manage and heal a variety of conditions.
In this issue, the imaginative work of several of the leaders in this field is put forward, and these leaders give us their insight, tips and pearls. This is fascinating work in a fascinating new world. However, a word of advice: the learning curve is long, even for otherwise accomplished surgeons, and the fact that a given procedure can be performed endoscopically does not mean that it should be performed that way. Together with technical advances, let us not forget that Codman, one century ago, stated clearly that we should continuously audit what we do in the operating theater, to make sure that it is safe, reliable, reproducible, effective, and efficacious. In the present climate, it should also be economically viable. So, have fun, but beware.
Nicola Maffulli, MD, MS, PhD, FRCS(Orth)
Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, UK
1. Maffulli N. Obituary—when somebody close to us dies, part of our future dies with them: John A. Fixsen, MChir, FRCS. J Orthop Surg Res. 2014;9:111.