Global Arthroscopy Foundation Guest Physician Visit Report:
Dr. Haiqing Cai, M.D.
Shanghai, China

“I have gained knowledge and improved my technique, but also working closely with Dr. Sweeney helped me to identify the best techniques to use, to get the best results in the operating room. Together, these have given me the confidence that I need to return to Shanghai and begin operating and teaching these techniques to the other surgeons at my hospital, and then beyond.”

~ Dr. Haiqing Cai, May 2004


Dr. Haiqing Cai, GAF Guest from Shanghai, China.(left), with Dr. Howard Sweeney, GAF President.

Without training, all the state-of-the-art equipment in the world will not result in the benefits that arthroscopic surgical patients should experience. Dr. Haiqing Cai, a pediatric orthopedic surgeon from Shanghai, visited Chicago in May 2004 as part of a program funded by Project Hope. During that time, she took part in the program through the Global Arthroscopy Foundation (GAF). As a result, she returned to China prepared to perform arthroscopic knee surgery and train other doctors, after having never before performed any type of arthroscopic surgery. Unlike many participants in GAF programs, Dr. Cai’s hospital is a state-of-the-art facility and she returned to an operating room equipped with proper supplies, equipment and tools. By providing her access to expert surgeons in the Chicago area, GAF was able to help her make the most of her hospital’s investment – and bring the benefits to the lives of her patients.

Dr. Cai, affiliated with the Shanghai Children’s Medical Center in Shanghai, China, visited Chicago for just over three months, between February and May 2004. In addition to observing doctors at Christ Hospital and Hope Children’s Hospital as part of the Project Hope program, Dr. Cai spent several weeks on three distinct opportunities with Dr. Howard Sweeney, head of GAF, participating in several types of surgical training. This included performing arthroscopy on cadavers in the Orthopedic Learning Center; practicing techniques on simulators and other training devices at Evanston Hospital; and observing such doctors at Dr. Gregory Palutsis in the operating room.

Dr. Cai, participating in a workshop at the Orthopedic Learning Center in Rosemont, Illinois.

Confidence in surgical technique and advancing her understanding of new techniques and procedures were the core benefits Dr. Cai derived from her GAF experience. “Dr. Sweeney has given me confidence,” Dr. Cai said. “Even if you know the surgery, if you don’t have confidence, you won’t succeed.” Arthroscopic surgery had never been performed in the hospital where Dr. Cai works. “She was the first,” Dr. Sweeney said. She has completed dozens of surgeries and is teaching other surgeons to perform them as well.

Dr. Cai’s confidence was built through hands-on training, something that was particularly educational for her. “You can watch, you can read, but the chance to practice means a lot,” she said. Dr. Cai began this training at the Orthopedic Learning Center, where she took part in a structured course on shoulder arthroscopy. This course is the basis for the surgeons’ learning, according to Dr. Sweeney. It also allows Dr. Sweeney to have a better sense of where these surgeons are coming from, what their particular strengths and weaknesses may be, the ways that they learn best, and the things that motivate them. This allows Dr. Sweeney to tailor the remaining training to better fit the particular doctor. After the course, the doctors use a computer simulation to help them feel more comfortable. “The ability to work with both hands and look at a television screen sounds simple, but it’s not,” Dr. Sweeney said of this learning experience.

“The hands-on training and one-on-one advice and guidance I received from Dr. Sweeney made the difference in my learning this procedure,” Dr. Cai said. “Observing is one thing, but practicing under expert guidance makes the difference.” After departing the Orthopedic Learning Center, Dr. Cai practiced the technique of triangulation in a lab at Evanston Hospital. This is a basic skill that every arthroscopic surgeon must have, which includes having an instrument in each hand and bringing them together inside a joint, while viewing the joint through a scope. “The triangulation lab at Evanston Hospital was very helpful in practicing and learning the proper technique necessary to perform arthroscopy,” Dr. Cai said.

Dr. Haiqing Cai, M.D., prcticing with a knot-tying station at Evanston Hospital, Evanston, Illinois.

Beyond hands-on experience, the GAF program introduced Dr. Cai not just to techniques necessary to perform arthroscopy, but also to what procedures are being performed in the United States, and what she could bring back to the hospital in Shanghai. She cited several specific examples: “Meniscus resection is fairly common (in Shanghai), but you do not see meniscus repair. I have observed quite a bit of arthroscopy in Shanghai, but I’ve never seen that procedure. It is not new here, but it is new in China and it is a surgery I can begin performing immediately that will greatly benefit the patients. I also have gained knowledge of how ACL procedures are performed here using the patella and bone graft. In China, we use the hamstring.”

Additionally, Dr. Sweeney provided Dr. Cai with the opportunity to observe several different American doctors – each with his or her own approach to arthroscopy. “Dr. Sweeney helped me to identify which techniques are the best,” Dr. Cai said. “For example, the bent-leg position I observed Dr. Palutsis using is different from the straight-leg method that is used elsewhere, as well as different leg holding methods. Dr. Sweeney is able to explain why one is better than the other.” Another method that was observed and discussed was the screw versus cross-pin, wherein Dr. Sweeney was able to demonstrate his choice.

Dr. Cai was chosen by Dr. Sweeney in part for her ability to bring the knowledge she gained while in Chicago to other doctors in Shanghai. Following the trip, she was able to return with even more value to her fellow surgeons that she expected. “I expected to return to Shanghai prepared to perform arthroscopy, but with another surgeon assisting who is more experienced,” Dr. Cai said at the time. “I now have the confidence that I can do this procedure on my own.” Dr. Cai immediately began teaching ten surgeons at her hospital upon her return to Shanghai. She detailed her more ambitious goals for sharing her knowledge beyond the Children’s Hospital as well. “Beyond the first ten (surgeons), I hope to teach these techniques and share the knowledge that I have gained with other hospitals, so many others can benefit from what I have learned. I have a PowerPoint presentation already prepared, which not only reports on my experience here, but demonstrates for other surgeons visually the points that I will be making regarding technique and why certain techniques are superior to others.”

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