AANA22: A Day-By-Day Recap
By: Todd C. Battaglia, M.D., M.S., FAANA
Greetings all! We have just wrapped up AANA22, May 19-21 at the San Francisco Marriott Marquis. The meeting corresponded with the organization’s 40th Anniversary. AANA Immediate Past President Mark H. Getelman, M.D., FAANA and Program Chair Kevin F. Bonner, M.D., FAANA put together an outstanding conference. This was our first "solo" annual meeting since the start of the COVID-19 pandemic and included over 100 e-poster presentations and 16 Instructional Course Lectures (ICLs). In addition, we welcomed faculty from our guest nations in the Pan-Asian region, including Thailand, Hong Kong and Korea.
Special programs, including the Residents and Fellows Program and Emerging Leaders Program, offered members early in practice expert advice in practice management, research activities, engagement with Arthroscopy, AANA’s peer-reviewed journal, and advancement within AANA. In addition, social relief and networking opportunities were provided through events including the AANA Golf Tournament, receptions, wine tours and dinners.
Day One (Thursday) was largely a "shoulder" day. Early sessions, including those led by John M. Tokish, M.D., FAANA and Ivan H. Wong, M.D., FAANA focused on the importance of bony involvement in shoulder stability. Several talks reiterated the significance of bone loss, both humeral and glenoid, in determining outcomes – even if the patient does not have frank recurrent instability! Strategies for calculation and management of bone loss, including Remplissage, Latarjet (open and arthroscopic) and distal tibial allograft (DTA), were all highlighted and made very clear that any surgeon treating shoulder instability must be prepared to address bony deficiencies with both arthroscopic and open approaches. Later, the focus shifted to rotator cuff and biceps/superior labrum. Particularly interesting were the various strategies for addressing massive and/or irreparable cuff tears. These included in situ biceps tenodesis, balloon spacer and superior capsular reconstruction (SCR) with autograft biceps versus hamstring allograft versus iliotibial band (ITB) versus dermal graft. It quickly became evident that there remains no consensus on a "best" strategy; even more interestingly, we remain unsure what factors are necessary for a successful outcome (does the SCR graft need to heal for a good result?). Similar debate surrounds management of the long head biceps – determination of which biceps and superior labral pathologies require treatment can be difficult, and no tenodesis technique (subpectoral, suprapectoral, top of groove) has been established as a gold standard. Concurrently in the afternoon, a session on hip femoroacetabular impingement (FAI) included discussion and demonstrations on labral augmentation and reconstruction, including a live surgical demonstration by esteemed Amherst College alum Andrew B. Wolff, M.D., FAANA.
Throughout Thursday, as with the remaining days, clinical debates regarding controversial cases offered multiple opinions on difficult clinical situations. I personally found these sessions some of the most useful, both in (sometimes) reinforcing my own inclinations and to suggest alternative viewpoints and techniques to consider. It is always heartening when even the "experts" do not agree on a best approach! Surgical demonstrations from Jonathan B. Ticker, M.D., FAANA, Nikhil N. Verma, M.D., FAANA and others also provided “live” instruction in many of the discussed techniques.
Day Two (Friday) focused, in large part, on knee issues. The day started with presentations concerning many different types of meniscal tears – including lateral meniscal oblique radial tears (LMORTs), root tears and radial tears – and repair strategies for each. Certainly, we are learning that indications, as well as success rates, for meniscal repair are increasing, and we now have the technology and skills to address many meniscal tears. Appropriate selection (of both patient and technique) remains crucial and debatable. The remainder of the morning focused on many aspects of anterior cruciate ligament (ACL) reconstruction, including graft selection, technical errors, extra-articular considerations (lateral extra-articular tenodesis (LET) versus anterolateral ligament (ALL) reconstruction) and postoperative complications. Of note is the increasing body of evidence suggesting that ALL reconstruction or LET significantly decreases subsequent ACL rerupture/failure rates. While few surgeons include this as a standard component of all ACL reconstructions, most are now considering it in specific situations (including revisions and severe rotational instability), and I expect it will be performed with increasing frequency and with expanding indications in the coming years.
In the afternoon, presentations discussed outcomes and cost-effectiveness of cartilage procedures. Even in 2022, preferences for osteochondral allograft versus cell-based therapies remain highly surgeon-dependent. The expert panel assembled to discuss cartilage cases, including Brian J. Cole, M.D., M.B.A., FAANA, Andres H. Gomoll, M.D. and Paul E. Caldwell, M.D., FAANA was headlined aptly: "It doesn’t have to be complex to be controversial." A concurrent session focused on extra-articular hip disease, including discussion and demonstrations of endoscopic hamstring repair (from Richard C. Mather III, M.D., M.B.A.) and endoscopic gluteal repairs (from Joshua D. Harris, M.D. and Jovan Laskowski, M.D., FAANA). In the final afternoon time slot, three concurrent programs focused, respectively, on shoulder surgery, practice management and knee controversies. Unfortunately, unable to be in three places at once, I chose to attend the latter and particularly enjoyed the debate on management of a proximal ACL avulsion via primary repair (espoused by Gregory S. DiFelice, M.D.) versus the bridge-enhanced ACL repair (BEAR®) technique (Eric C. McCarty, M.D.) versus formal reconstruction (Elizabeth Matzkin, M.D.) Pearls and demonstrations for complex ligamentous reconstruction, including collateral, posterior cruciate ligament (PCL) and multiligament situations, were provided by Robert F. LaPrade, M.D., Thomas M. DeBerardino, M.D. and Gregory C. Fanelli, M.D.
In addition, Friday highlights included two keynote speakers. The first was Eric W. Carson, M.D., who presented this year's Diversity Guest Lecture, a moving account of his experiences as an African American Orthopaedic Surgeon. Later, in the Presidential Keynote Address, Alison Levine discussed "high impact leadership," reflecting on her career as one of the world's top mountain climbers and leader of the first American women's expedition up Mount Everest.
Day Three (Saturday) covered a hodgepodge of special topics. Especially interesting were case panel discussions devoted to unpublished clinical pearls from, and complications experienced by, some of our AANA leaders, including John C. Richmond, M.D., Alan S. Curtis, M.D., FAANA, John D. Kelly IV, M.D., FAANA and Jeffrey S. Abrams, M.D. Later, a session led by Rachel M. Frank, M.D. focused on prevention and management of complications in knee and shoulder surgery. Together, the morning was a great reminder that things can go wrong even for the most skilled of us, and that deft handling of these misadventures may truly be the mark of a great surgeon. Afternoon sessions focused first on the patellofemoral joint (including instability treatment algorithms and management of chondral defects); second on orthobiologics (nonsteroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP)); and third on degenerative joints in the aging athlete (usefulness of arthroscopy, arthroplasty outcomes). Finally, the gavel was passed from outgoing AANA President Dr. Getelman to incoming president James W. Stone, M.D., FAANA.
Special kudos to Stephen J. Snyder, M.D., who received AANA’s 2022 Lifetime Achievement Award, and to Richard L. Angelo, M.D., Ph.D. and Nicholas A. Sgaglione, M.D. recipients of the Distinguished Service Award.