Birth of Wrist Arthroscopy

Gary Poehling, MD, laughed when asked why he remembers the exact date of the dinner he had with two other orthopaedic surgeons that became the basis for the start of wrist arthroscopy in the United States. It was a laugh borne from the knowledge of the setting–a restaurant overlooking the scenic Salza River in Austria, the place where the Sound of Music was filmed–as much as the discussion itself.

How could he possibly forget that combination of place and significance?

Poehling knew that he and his friends Jim Roth, MD, of the University of Western Ontario in Canada and Terry Whipple, MD, of Richmond, Va., had all been experimenting with the concept of wrist arthroscopy (arthroscopic surgery of the knee was still in its infancy at the time). So Poehling invited them to dinner. With the beautiful scenery of the river just outside, the three men began to compare notes.

“We started to share our different experiences of the various problems that we had and how we were solving those problems,” he said. “We felt like this could be a real clinical tool. There wasn’t a great deal of understanding about all of the things, but when you pooled all of our data together, I think we had a strong story.”

A Summit is Held

They decided to hold a conference, and in January 1986, 47 physicians from a list of 57 of the top orthopaedic physicians and surgeons in the country gathered in Winston-Salem. The effort was helped, Poehling said, in part because of the approach to be inclusive and invite veteran surgeons as well as those newer to the field.

“Many of the leaders in knee arthroscopy weren’t involved in any of its development, and we felt like that held the whole field back. We decided that this would be better if we shared our experience with the leaders rather than just a lot of young people.”

From there, wrist arthroscopy grew. The minimally invasive technique is accomplished by making small incisions in the back of the wrist joint and, like knee arthroscopy, using a scope to see inside so corrections can be made.

Wrist arthroscopy, Poehling said, allowed orthopaedists to diagnose things they did not know even existed, such as partial tears of certain ligaments, and to understand more about the workings of the triangular fibrocartilage inside the wrist. Another benefit was that because wrist arthroscopy was less invasive with the small incisions compared with regular surgery, the recovery time was shorter.

Legacy of Wrist Arthroscopy

Poehling became editor of Arthroscopy: The Journal of Arthroscopy and Related Surgery in 1989, a position he still holds. He said the advances in wrist arthroscopy over the years have been significant, just as they have foreshadowed changes in related fields, a trend he believes will continue.

For example, elbow arthroscopy was developed within a few years of wrist arthroscopy, and hip arthroscopy followed that, along with robotic knee replacement. Research being done now could find regenerative medicine solutions for orthopaedic problems, Poehling said, and more is on the way. So the original work at Wake Forest Baptist with wrist arthroscopy has been important for orthopaedics.

“What it has done for us is give us recognition,” he said. “It’s given us opportunities to participate in other things. It opens doors to other innovative aspects.”