Closing: The limitation of shoulder arthroscopy

Abstract

Being firmly convinced that there are no limits to the ingenuity of humans, whether in outer or inner space, the assignment to produce a closing editorial on the limitation of shoulder arthroscopy challenges both imagination and introspection. Forty years ago, I recall watching my urologic colleagues as they peered awkwardly into a urethroscope; wallowing in water, they were busily engaged in clearing a passage for the vital flow of effluent. A sign on the door labeled the area Duck Pond. These primordial endoscopists, along with the bronchoscopewielders who extracted peanuts and safety pins through a choking larynx, were the true progenitors of contemporary endoscopy. The proliferation of duck ponds is engulfing more and more orthopedic surgeons, who emerge from the operating room with wetted socks and underwear, and their interest whetted to explore and operate within every articulation. Shoulder arthroscopy, the mutant child of mother knee arthroscopy, is but a way station on the road to the lesser articulations. This inner space-age technology has spawned a medicalindustrial complex that fuels and propels the sons and daughters of other specialties as well. The abdomen has been invaded and inspected by the general surgeon after trauma, only to later lose a gallbladder and appendix to endoscopic intervention. The colposcope, in the hands of the gynecologist, has already led to the harvesting of ovum and a myriad of other applications. Today, the cardiologist vies with the radiologist for the right to visualize the lumen of arteries and even extricate obstructions that threaten the viability of our hearts. Surely we have not yet reached the limitation of shoulder arthroscopy. Just as surely we have not yet confirmed the indications or concluded the end results of the techniques presented in this publication. Ernest Codman, the grandfather of modern shoulder surgery, was often condemned by his colleagues for his insistence that they develop end-result studies. We hold in our hands a volume on techniques in shoulder arthroscopy, with contributions by outstanding physicians whose dedicated work has innovated or advanced this subject. Technical mastery is difficult to achieve, and follow-up studies require a full measure of time and integrity. When my report Arthroscopic Subacromial Decompression: Analysis of One-to-Three-Year Results appeared in the ]ournal of Arthroscopy in 1987, the Editor, S. Ward Casscells,