The origins of BESS

Apart from the rare operation for infection or trauma, shoulder surgery in Britain was limited to procedures for recurrent dislocation until the 1970’s. These operations were pioneered by Bankart and Platt, both still revered eponymously for theirforesight and skill. In the 70’s interest in the shoulder gradually blossomed. Reeves arranged an international meeting for interested surgeons in Leeds in 1972, and in 1980 in London Kessel and Bailey organised a gathering of surgeons from across the globe to discuss surgery of the shoulder. The proceedings were published in “Shoulder Surgery”, setting a precedent for later meetings. Welsh and Bateman organised a similar international meeting in Toronto in 1983, and the pattern was set: International shoulder surgery conferences were to be held every three years in different countries, hosted by local experts.

It was during this time too (1982) that the shoulder surgeons in North America formed their association. They included the elbow in their field of interest for it was felt that this joint was not receiving the attention it deserved. Later national and international groups came to the same conclusion, and included the elbow in their realms. The next international meeting was arranged by Takagishi in Fukuoka in Japan in 1986. This was a huge gathering, and it was here that it became clear that most nations needed a forum in order to encourage the spread of knowledge and allow discussion of new techniques locally.

Accordingly, Michael Watson, Ian Bayley, Steve Copeland and Angus Wallace met in the former’s office in the spring of 1987 in order to set up the mechanics of the British Elbow and Shoulder Society. It was decided that yearly meetings would be appropriate, and that regular educational gatherings should be encouraged. The Society was set up so that other medical workers in addition to surgeons would be encouraged to join. It was felt that this would facilitate width as well as depth in the Society’s transactions. The first meeting was hosted by Kelly in Glasgow in 1988. The next year Souter arranged the meeting in Edinburgh, when the pattern for future occasions was established.

Also in 1987, inspired by the Fukuoka conference, Patte and Gschwend inaugurated the European Elbow and Shoulder Surgery Society at a meeting in Paris. There was immediate interest in involving the British Society, and a mutual exchange of personnel and ideas began. Indeed, Michael Watson was president of the European society in 1988/9. In fact several European shoulder and elbow societies were formed then, and all have become associated with the continental umbrella organisation of what has become known as “SECEC”. Other continents evolved similar groupings around this time, and a global arrangement of continental societies now exists.

Thus a three-tiered system has evolved. National societies for shoulder and elbow practitioners (like BESS) are represented at international level by their continental societies (like SECEC). The International Conferences held every three years remain the chief forum for education and discussion both by the national and continental groups.

A good deal of discussion about a journal for the subspecialty took place during these years. Should each national group have its own publication? Eventually it was agreed that a single international journal should be supported, The Journal of Shoulder and Elbow Surgery. It was to have an arrangement whereby editorial control was divided between the participating nations. The journal first appeared in 1992 under the chief editorship of Robert Cofield, and it has become the most influential mouthpiece of shoulder and elbow practitioners worldwide.

BESS remains the main organ of communication and education for British shoulder and elbow surgeons. Instructional courses are held often, and have proved a valuable forum for the advancement of techniques. Those who have attended will know also of ideas which have disappeared, almost without trace, following acrimonious discussion at such meetings. Gatherings to discuss controversies have proved popular with BESS members too. Master classes are always extremely useful. One of the highlights of the Society’s early days was Harvard Ellman’s elegant demonstration of arthroscopic subacromial decompression at the London Bridge Hospital soon after he developed the technique.

By Mr Michael Watson, Honorary and Founding Member of BESS