AANA25 Shoulder Access Pass-GENERAL SESSION: ISAKOS and AANA: The Great Debates (Main Stage)

Video Transcription

Video Summary

The General Scientific Session, a collaborative symposium between ISSAKOS and AANA, featured a series of expert debates moderated by Drs. David Parker and Michael J. O'Brien, covering complex orthopedic topics. The session engaged audiences interactively via live voting on debate winners.<br /><br />The first debate focused on revision ACL surgery in a young athlete with graft re-tear and addressed graft choice, lateral extra-articular tenodesis (LET), and slope-reducing osteotomy. Dr. Parker advocated for contralateral BTB graft and LET, citing strong evidence for LET's efficacy and lower morbidity compared to osteotomy, which lacks robust clinical evidence. Dr. Seth Sherman preferred the quadriceps tendon graft and emphasized slope-reducing osteotomy’s role, especially with higher posterior tibial slopes, arguing that LET alone is insufficient in such cases. The audience favored Dr. Parker’s evidence-based approach.<br /><br />The second debate discussed treatment options for massive irreparable rotator cuff tears. Dr. Emilio Calvo supported lower trapezius tendon transfer for restoring external rotation and function, while Dr. Joe Turow favored biceps-augmented rotator cuff repair as a simpler, less invasive alternative better suited for pain relief rather than strength restoration. Both highlighted the importance of patient-specific factors.<br /><br />The third debate debated isolated MPFL reconstruction versus combined bony realignment for patellofemoral instability. Dr. Mario Ranga supported isolated MPFL in most cases with careful risk factor evaluation, whereas Dr. Richard Arendt advocated for combined bony corrections to address underlying anatomic abnormalities, citing clinical experience and data. The audience favored bony alignment correction.<br /><br />The fourth debate compared Latarjet procedure versus distal tibial allograft (DTA) for glenoid bone loss in shoulder instability. Dr. Guillermo Arce favored Latarjet for vascularity, capsule replacement, and cost-effectiveness, while Dr. Rick Scheller emphasized DTA’s preservation of anatomy, reproducibility, and equivalent outcomes with less soft tissue disruption. The debate was close, reflecting evolving practices.<br /><br />The fifth debate on cartilage restoration covered fresh osteochondral allografts (OCA) versus a novel biphasic coral-based scaffold. Dr. Thomas Bernardino supported OCAs for durable, viable cartilage replacement with strong clinical history, whereas Dr. Liza presented coral-based scaffolds offering logistical and regulatory advantages with emerging evidence. Rehabilitation protocols differ, with OCAs allowing earlier mobilization.<br /><br />The session concluded with talks on pyrocarbon shoulder hemiarthroplasty and patient-specific instrumentation (PSI) for osteotomies. Dr. Rob Hartsler highlighted pyrocarbon's favorable biomechanics and survivorship compared to metal hemiarthroplasty, especially in young arthritic shoulders, emphasizing meticulous surgical planning. Dr. Mike Alea advocated PSI to enhance accuracy, reduce complications (e.g., hinge fractures), and streamline complex osteotomies, promoting adoption over traditional techniques.<br /><br />Overall, the session showcased cutting-edge debates blending evidence, experience, and innovation in orthopedic sports medicine and shoulder surgery, underscoring the value of international collaboration and diverse expert perspectives.

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Keywords

General Scientific Session

ISSAKOS

AANA

orthopedic debates

ACL revision surgery

lateral extra-articular tenodesis

slope-reducing osteotomy

rotator cuff tear treatment

lower trapezius tendon transfer

biceps-augmented rotator cuff repair

MPFL reconstruction

bony realignment

Latarjet procedure

distal tibial allograft