AOSSM/APKASS 2022 Traveling Fellows Tour

First Stop: Kobe, Japan

September 8 - September 14, 2022

Written by F. Winston Gwathmey, MD

After 12-hour trans-Pacific flights, the AOSSM traveling fellows all met at the airport in Tokyo, Japan to embark on a four-week tour through Southeast Asia. We took a quick flight to Kobe, gathered our luggage, and walked out the baggage claim to a very welcome sight, our Japanese hosts Yuichi Hoshino, Kyohei Nishida, and Yuta Nakanishi with the familiar AOSSM signs. Our packed Japan experience was set to begin!

Our first day (Friday) in Japan was surgical observation. Cassandra and I went directly to Kobe University Hospital while Chuck and Jas went to another hospital to observe a revision ACL with Dr. Yuichi Hoshino. At Kobe University, we observed a complex patellofemoral instability case with Dr. Take Matsushita treated with a femoral derotational osteotomy and MPFL reconstruction. Everyone reconvened at Kobe University in the afternoon to observe Dr. Hoshino expertly perform a double bundle ACL reconstruction. Professor Ryosuke Kuroda and the entire sports medicine division welcomed the traveling fellows that night for a beautiful dinner that set the tone for our culinary tour of southeast Asia.

On Saturday, our Japanese hosts met us at the hotel for what was advertised as an easy hike by our marathoner tour-guide Takeo Tokura. Three hours and five strenuous miles later we had climbed the 2300 foot Maya mountain despite the 33 degree heat. We celebrated with an outstanding Kobe beef barbecue overlooking the city of Kobe. After a well-deserved rest, we enjoyed the league champion Orix Buffaloes baseball game in Osaka that night followed by tasty ramen. On Sunday, we traveled by Shinkansen bullet train to Kyoto and toured several Buddhist temples and Shinto shrines. We were introduced to the training regimen of the Buddhist monk that included “constructive feedback” with a bamboo stick. We enjoyed a fantastic tempura dinner in Kyoto with the team.

Monday, we toured the Kobelco Steelers rugby team facilities with Professor Kuroda and his team and met with the coaches and training staff. We then had lunch with the legendary Professor Kurosaka who mesmerized us with his innovative approach to orthopaedic surgery and building the department in Kobe. We toured the Fukuju sake brewery and enjoyed a Kobe steak dinner that evening. Tuesday was spent in the clinics of Kobe University Orthopaedics. The traveling fellows put on white coats and saw patients with Professor Kuroda and his team and witnessed many extraordinary outcomes after surgery. In Japan, all surgical patients follow-up annually for five years after surgery and provide PROs, strength data and complete routine follow-up MR imaging. This practice allows the compilation of extensive data and information about surgical outcomes. After an academic session with the department that afternoon, Professor Kuroda took us to an absolutely outstanding sushi dinner with his team to cap off an unbelievable Japan experience.

A Busy Week in Seoul, South Korea

September 14 - September 20, 2022

Written by Cassandra Lee, MD

Full of sushi and Kobe beef, we headed to Seoul, South Korea arriving in the domestic airport. We were met by the team leader of Myongji Hospital’s Sports Medicine Center and the “Dr. Car.” After being shuttled to the international airport testing center for visitor arrival COVID testing, we checked into our hotel in the Gangnam-gu district, the area made famous by Psy’s pop song “Gangnam style.” It was clear we were in the land of Samsung - looking outside of our hotel window, there were at least 15 massive digital billboards of incredible definition, some well over 50 feet wide.

We first visited Professor Joon Ho Wang at the Samsung Medical Center. We were struck by the order and automation of registering and checking in patients in the lobby. From an arthroscopic standpoint, it was the first time we had all observed the use of the transseptal portal in the back of the knee in such a facile manner to address meniscal ramp and root tears. In between cases, Professor Wang shared with us some of his research on meniscus repair techniques and outcomes in addition to expertly demonstrating the SMC knot. That afternoon, we had a joint Korean arthroscopic society and AOSSM symposium where we exchanged our respective knowledge on the current trends of ACL reconstruction and graft choices, hip arthroscopy, and joint preservation. A traditional Korean dinner followed with Cassandra discovering her namesake beer in Korea (Cass beer).

The next day, we went to Kyung Hee University Hospital to observe Korean Arthroscopic Society President Professor Kyung Ho Yoon. Again, use of the transseptal portal was used for remnant sparing PCL reconstruction. As in Japan, the graft master (here a PA) expertly and tightly prepared the soft tissue allograft for reconstruction. We were treated to an incredible Korean BBQ dinner at a tiny restaurant of consisting of 4 small tables at the Meat Market district.

Coming into the weekend, our hosts showed us around Seoul. We first visited the Gyeongbokgung Palace, where we all opted to dress up in traditional Korean clothing (hangook). For lunch, we experienced spicy chicken soup (daek bockeum tang), which apparently had been tamed down for our North American palettes. Because of the unseasonable hot weather, we toured the air-conditioned Blue House, the former official residence of the president of South Korea.

The Korean language is phonetic, and the alphabet was created in a way that anyone can read. Winston was determined to learn the Korean alphabet, carrying his sheet with him, reading signs everywhere we went. Our day was topped off with a tour of a traditional Korean Hanok village and the fellows later visited the ex-pat friendly Itaewon district.

A much-needed break was taken on Sunday. That afternoon, Winston and Cassandra ventured to the Hongdae district, an artsy urban area with an indie vibe, exploring small shops and street vendors where street performers included an all-female dance group in the K-pop style and then a metal band on another block. We met up with the entire group and toured the Lotte tower, the tallest building in Korea standing at 555m and 123 stories, overlooking the entirely of Seoul.

On our last full day in Seoul, we visited Professor Jin Goo Kim at the Myongji Hospital in the outskirts of Seoul. He had an impressive 15 cases scheduled that day ranging from ACL, PCL reconstructions, to meniscus allograft transplants, to HTO, to chondral cartilage implantation. In the mid-afternoon as cases were winding down, we were taken to the DMZ and the Freedom Bridge in Imjingak.

Singapore

September 20 - September 25, 2022

Written by Charles Bush-Joseph, MD

The third leg of our trip required a 7-hour flight from Seoul to Singapore. We were met by our primary host, Dr. Dave Lee from National University Hospital Singapore who promptly took us for evening drinks at the famous Marina Sands Rooftop Bar with fabulous views of the downtown and seafront area.

The next morning we presented lectures to the orthopaedic staff, students and residents and moved to the operating rooms observing several complex knee procedures with Dr. Lee. He was challenged to repair a chronic locked bucket handle meniscus tear before completing an ACL reconstruction with IT band tenodesis. We had an interesting lunch with orthopaedic department chairmen Dr. James Hui at the famous Tangelin Club, that dates back to the British colonial days in 1866.

The next day, we moved over to Singapore General Hospital spent the day with Dr. Denny Lie who is head of sports medicine with the Duke University affiliated medical school and training program. Dr. Lei performed several rotator cuff repairs and used the balloon spacer devices as an augment to the repair. A tour of Chinatown took us back to the roots of Singapore’s heritage and more local food that Winston eagerly tried. Finally on Saturday, we participated in the city wide Orthopaedic Grand rounds with lectures and multiple case presentations that led to lively and varied discussions before exchanging gifts. An afternoon of kayaking in Singapore Bay was followed by a cycling around the waterfront before again retreating to our usual 8-10 course Asian dinner. Sunday morning required a short flight to Bangkok and hopefully a day of fasting.

Two Stops in Thailand Starting with Bangkok

September 25 - September 28

Written by Jas Chahal MD, MBA, FRCSC

On the final leg of the AOSSM/APKASS Travelling Fellowship we arrived in Bangkok on Sunday, September 25 where we were greeted at the airport by Dr. Nahdaporn Saengpetch (Dr. Obb) and his team. That evening, we met Dr. Obb’s team for a fantastic Thai meal at the Supanniga Eating Room followed by a tour of Old Bangkok.

The next day, we visited Dr. Bancha Chernchujit at the Thammasart University Hospital where we observed him perform a complex rotator cuff repair (subscapularis, bursal sided supraspinatus, arthroscopic biceps tenodesis), anterior cruciate ligament reconstruction with hamstrings autograft and percutaneous LCL reconstruction, as well as, a PCL reconstruction with peroneus longus autograft.

During the day we had the privilege of meeting the Dean of the Medical College and following surgery we were hosted for another great dinner by Dr. Bancha.

On Tuesday, September 27, we visited Ramathibodi Hospital and were provided the opportunity to give our presentations as part of a virtual TOSSM conference with Dr. Obb and his team. Later that day we went sight seeing on a scooter tour of old Bangkok and then met the TOSSM and ISAKOS course faculty at the Blue Elephant Restaurant for Dinner.

The Final Stop in Pattaya, Thailand for the APKASS Congress

September 28 - October 2, 2022

Written by Jas Chahal MD, MBA, FRCSC

From September 28 to 30 we traveled to Pattaya, Thailand for the 2022 APKASS Conference where we reunited with old friends and colleagues from our AOSSM APKASS Tour over the preceding month. It was a privilege to watch Dr. Chanakarn Phornphutkul hand off the baton for TOSSM presidency to Dr. Bancha. Both leaders were inspirational and were world class hosts during our stay in Thailand!