Arrival in Barcelona
Written by Brian R. Waterman, MD
After two years of rescheduling in the wake of the COVID pandemic, the time for the AOSSM-ESSKA fellowship has arrived. Equipped with an ambitious travel schedule and a true Italian-American Godfather (Annunziato “Ned” Amendola) of the highest form, the three traveling fellows embarked on a transatlantic flight under the cover of night. Mary Mulcahey (Tulane), Xinning “Tiger” Li (Boston University) and Brian Waterman (Wake Forest) capitalized on a few hours of sleep on the flight and hit the ground running with a walk to Montjuic, a light order of tapas for lunch, and a late OR start with host, department chair, and ESSKA 2nd Vice President Joan Carlos Monllau.
They observed his technique to perform high tibial osteotomy and deflexion osteotomy with an over-the-top approach for second time revision ACLR in a professional athlete. On the second day, the fellows got some much-needed rest and joined The Godfather for a robust and complex day in the OR at the Hospital de l’Esperança:: reverse shoulder arthroplasty, meniscal transplantation, root and LMORT meniscal repairs, posterolateral corner reconstruction, and distalizing tibial tubercle osteotomy with MPFL reconstruction.
After the morning OR, plentiful tapas were served in a local restaurant, the group was treated to a guided tour of Gaudi’s La Sagrada Familia, which was truly a masterpiece to behold. Dinner was served in the beautiful Tibidabo restaurant, La Venta, with gorgeous panoramic views of the Barcelona coastline. On the third day, the fellows were treated to a cadaver lab at the historic medical school, where they exchanged techniques and surgical pearls for success during open knee and shoulder procedures. Thereafter, lunch and wine tasting was provided at the famous Torres winery. While their palates were not quite as developed as their surgical skills, the fellows enjoyed the paired menu and interactions with faculty from The Hospital Del Mar.
Finally, on the last day in Spain, there was an academic program with lectures from the traveling fellows and faculty on wide ranging topics from ACLR infection to meniscal scaffolds and trochleoplasty. The fellows presented on special considerations for ACL tears in the female athlete, medial corner injuries in the multiligamentous knees, and posterior shoulder instability. The faculty and residents were incredibly engaged, and gifts of gratitude were exchanged before being whisked away by our driver to the airport. Without question, this was an extraordinary stop in Barcelona with Prof Monllau and his team, including Carlos Torrens-Canovas, Simone Perelli, Raul Torres-Claramunt, Juan Sánchez-Soler, Pedro Hinarejos, Fernando Santana, and Daniel Pérez-Prieto, who provided unparalleled hospitality and great new friendships. ¡Gracias!
Continuing on to Luxembourg
Written by Mary K. Mulcahey, MD
On the second stop of the AOSSM/ESSKA traveling fellowship, we visited Luxembourg. Unfortunately, our bags did not arrive in Luxembourg because of a very short connection in Munich. Dr. Romain Seil, his wife, Katy, and practice partners Drs. Victor David, and Pietro Spenacchio greeted us at the airport. Given the mishap with the luggage, Dr. Seil very graciously took us to a local store to buy some essentials before heading to dinner at Restaurant Mosconi, which was nestled in the historic portion of the city.
The following day, Dr. Seil and his team treated us to a rich history lesson with a tour of the Luxembourg-American Cemetery and a visit to two different World War II Museums. The day was capped off with a delicious dinner with Dr. Seil and his team at the restaurant in Hostellerie du Grunewald, which featured traditional French dishes.
On the second full day in Luxembourg, we observed Drs. Dietrich Pape and Alex Hoffmann perform two total knee arthroplasties using a new navigation system at the Centre Hospitalier de Luxembourg (CHL). We also had the opportunity to visit ESSKA headquarters, which is located in a building adjacent to the hospital. There, they met Zhanna Kovalchuk (Executive Director), Joseph Ramesh (Project Manager - Education), and several staff members. We were treated to tea, coffee, and delicious pastries from a local bakery.
That afternoon, we went on a walking tour of the historic part of Luxembourg city, which features castle towers and cobblestone streets. The day concluded with an engaging academic session at House 17, during which we discussed patellofemoral cartilage restoration, Clinical Practice Guidelines for managing rotator cuff tears, and advocacy for athletes. In exchange, we learned about this program’s robust ACL clinical research database led by Caroline Mouton, strong knee biomechanics research from Dietrich Pape, and plans for an extensive human motion analysis laboratory presented by Jan Cabri.
On the final day, we observed Dr. Spenacchio perform a Bankart repair, followed by several complex knee cases with Dr. Seil during which he demonstrated his two posteromedial portal technique for ramp repair, quadriceps tendon autograft harvest, and revision ACL reconstruction. The hospitality, camaraderie , research, surgical expertise, in addition to learning about the American contributions in WWII, especially the Battle of the Bulge, was impressive. We are very appreciative as we move on to our next stop in Bologna.
Written by Xinning Li, MD
We arrived in Bologna, Italy for our third stop of the AOSSM-ESSKA traveling fellowship. We were greeted late at night at the airport by three senior residents, Gian Andrea Lucidi, Giacomo Dal Fabbro, and Piero Agostinone. They were extremely welcoming and took us to our hotel. Gian drove his Volkswagen like a Ferrari through the streets of Bologna, while Giacomo drove his Saab like a minivan. After we checked into the hotel, we walked to the city center and had a great conversation with all three residents regarding the differences in training between the Italian and United States system. The residency program in the Rizzoli Orthopaedic Institute recently increased the number of interns from 20 to 38 with a total of 130 residents in the program.
The next day, we had a delicious breakfast at the hotel and met with Professor Stefano Zaffagnini at the Rizzoli Orthopaedic Institute. He had planned an amazing day of surgery with a total of 10 cases, including several ACLs using semi-T/gracilis over the top with lateral plasty technique, revision ACL with fresh Achilles tendon autograft, TTO/MPFL reconstruction, lateral meniscus transplant, HTO, ACL with xenograft (one of the first one done in Europe), and pediatric open physis ACL. It was very educational for all of the AOSSM-ESSKA traveling fellows to experience, even our Italian Godfather was impressed with the surgical techniques and systematic operating room efficiency. In between cases, the traveling fellows were doing sets of push-ups to work off the cannolis and pasta.
After the long OR day, Dr. Zaffagnini and his right-hand man, Alberto Grassi took us out to a wonderful seafood restaurant where we had our first taste of the traditional Bologna cuisine. According to Wikipedia, the best pasta in Italy comes from Bologna! We finished the meal with a nice Italian night cap, Vecchio Amaro del Capo, a popular drink from Calabria, Italy, the homeland of our godfather.
On the second day of our visit, we started with the Academic session in the historic Campanacci Auditorium. The AOSSM-ESSKA fellows and Godfather discussed Osteochondral Transplant in the Ankle, Anterior shoulder instability – US experience (Tiger), Biologic knee reconstruction (Brian), and Sex differences in ACL Injury (Mary). Prof Zaffagnini and Dr. Grassi presented their very impressive experience in ACL surgery, and meniscus transplant that included over 370 patients and 10 plus years of follow-up.
After the academic session we had the privilege of touring the ancient Rizzoli library and the museum of Prof. Putti’s office. Then Dr. Zaffagnini took us to the Ferrari Museum at Maranello Modena in his own Ferrari with the Godfather.
The fellows travelled out with the VW and Saab, but Gian was once again driving his VW like a Ferrari through the country. Thus, the fellows did feel like they traveled to the museum in a Ferrari. Then we had an unpretentious dinner at the Ristorante Cesarina to once again experience the best pasta in Italy! The following day, we visited the Isokinetic FIFA Medical Center at Casteldebole, which was a really informative experience.
The Bologna visit was truly amazing and special, especially, given our Godfather grew up in Italy. This trip brought up a lot of emotions for our Godfather and we are grateful to have experienced this beautiful country in just a few days. Next up on the schedule, London, England!
Six Sunny Days in London
With Bologna in our rearview mirror, we took a hop across the Channel to southern England for the extended Easter weekend. After a classic British pint, spicy shawarma, and good night’s rest at the Z Hotel in Westminster, we were ready for everything that London had to offer… including most importantly, its posh neighborhood gym, which was a godsend at this stage in the trip. Our hosts from the Fortius Clinic, Andy Williams and James Calder, had arranged an excellent series of sporting events or us on arrival, starting with a make-or-break playoff rugby of the local club, the Harlequins, against their sturdy rivals from Montpelier. After a short Tube ride with fellow, David Sime, we met met Andy and his anesthesiologist, Mark Kenny, at the stadium in Twickenham, where we “braved” the unseasonably warm weather (14 degrees celsius) and raucous home fans. Despite a home win and inspired play, the hosts suffered a narrow defeat on aggregate. To bolster morale, we swung by Mark’s favorite neighborhood pub for some warm beer, scotch eggs, and more “football” on the patio, where we watched the FA Cup Semifinal of Liverpool-Manchester City. We walked along the Thames talking with our hosts and indulged in some gelato and fish & chips before retiring for the day. Truly a fantastic first day in the UK!
On Sunday, we were treated to even more gorgeous Easter weather and were able to scratch another item off our bucket lists with tickets to the West Ham United-Burnley at the Olympic Stadium. On Monday, we enjoyed a casual morning at the gym followed by a quick bite in Chinatown, where Tiger pulled out his Mandarin and ordered for the table. Afterwards, we did a walking tour of Piccadilly Circus, Trafalgar Square, Westminster Abbey, and Big Ben that even Clark W. Griswold would’ve been proud of. Later that evening, we joined Andy, his wife, Jo, and their children, Isaac and Polly, at their house for a home-cooked meal and conversation on work-life balance, elite athlete care, and excellence in the clinical setting. Andy’s appreciation for his family and high-profile patients were readily evident, and we enjoyed the opportunity to share this time together during their holiday weekend.
On Tuesday, we were back in the throes of clinical activity with our first day at the Fortius Clinic, a unique private practice clinic and surgical suite in Marylebone. With a uniquely collaborative environment among their anesthesia, nursing, and surgical staff, we were treated to well-executed cases in the OR and new techniques for treating injuries of the MCL, anterolateral ligament complex, and Achilles tendon in professional, high demand athletes. Andy, James, and their partner, Simon Ball, all showcased their surgical talents and time management skills, and we also enjoyed the chance to shadow Andy in clinic, where he cared for several elite soccer, rugby, and cricket athletes with complex injuries. James hosted us at the prestigious Cavalry & Guards Club, where we enjoyed a “proper” London welcome with exquisite wine, food, and personalized experience. In our last morning with the group, Andy shared his passion and approach for the medial collateral ligament complex, while James reviewed his work with ankle instability, followed by free time to engage in Q&A. After the OR that evening, we enjoyed one final evening with our hosts at Cambio Del Tercio, exchanging gifts, banter, and plans to collaborate in the future. In the words of our host, truly a “top job”! Thank you for accommodating us over Easter and “cheers” for all your generosity and hospitality!
Written by Mary K. Mulcahey, MD, FAAOS, FAOA
When we arrived in Oslo, we were greeted by our host Dr. Lars Engebretsen, who then brought us to Olympiatoppen Sportshotel, the Norwegian Olympic Training Center, where we stayed for the next two nights. That evening, we enjoyed a typical Norwegian dinner at the house of Lars and Britt Engebretsen, and we were joined by his practice partner, Gilbert Moatshe. We started the following day with a great workout in the Olympic facilities and a run around the beautiful Sognsvann lake at sunrise. We then joined several of the faculty from the Oslo University Hospital and the Oslo Sports Trauma Research Center for an engaging and multifaceted academic session. We gave talks on anterior shoulder instability, biologic knee reconstruction, and ACL tears in the female athlete, while our Norwegian colleagues covered topics including open vs arthroscopic Latarjet and multiligament knee injuries.
Throughout the day, we had a rich discussion about numerous clinical topics, and we gained an appreciation for the Norwegian Olympic Center philosophy and ongoing work at the Oslo Sports Trauma Research Center. After dinner with the group at Olympiatoppen, we traveled downtown with some of our hosts. We enjoyed a beautiful walking tour of the waterfront at sundown, and we ventured onto the roof of the magnificent Oslo Opera House, which overlooks the Oslo fjord. We closed out our visit to Oslo by sharing some drinks at a local brewery with our newfound friends, Drs. Berte Boe, Andreas Persson, Gilbert Moatshe, Sverre Loken, and Marc Strauss before catching an early flight to Lyon, France the next day.
For the last stop of the AOSSM-ESSKA tour, we arrived in Lyon (France) to join our Godfather, Ned. After we checked in, the group was re-united and had a traditional Lyonnaise cuisine for lunch in the old town. We were then picked up from our hotel by our hosts, Guillaume Demey and Jean-Marie Fayard for our scientific session featuring talks from both the AOSSM Traveling Fellows and Faculty from the Lyon School of Knee Surgery. Topics included Knee Osteotomies and combined biologic resurfacing (Ned), Adding a lateral extra-articular procedure at the time of ACL reconstruction reduces graft rupture rates (Jean-Marie), ACL tears and sex differences (Mary), Comparing opening vs closing wedge osteotomies (Axel), patellofemoral cartilage restoration (Brian),and Update to the AAOS Clinical Practice Guidelines for the management of rotator cuff tears (Tiger). Tiger received the honor of giving the first ever shoulder talk to the Lyon School of Knee Surgery.
After the scientific session, our hosts treated us for dinner at the much-anticipated Paul Bocuse Restaurant. This is one of the only 27 three-star Micheline restaurants in France and Paul Bocuse is considered the father of French Cuisine and Lyon gastronomy. We had an amazing experience discussing life, surgery, culture, and food. The night ended with a guided tour of the kitchen and wine cellar, where we found 10 bottles of Grands Echezeaux from 1946.On Sunday, Guillaume planned an enjoyable day beginning with a walking tour of the Notre Dame of Lyon, Roman ruins and the Old Town of Lyon. We learned that Lyon is spread over a narrow peninsula between the Rhone and Saone rivers. On the right bank of the Saone, is the Old Lyon (Vieux Lyon),which remains one of the finest surviving architectural complexes of the Renaissance era in the world. Guillaume, also a wine connoisseur, booked an amazing paired wine tasting at the newly transformed Hotel Diex–hospital, now the Inter-Continental Hotel followed by an excellent lunch. This was the first wine tasting event for the hotel. We as a group learned about the finer points of the first, second, and third “nose” of wine tasting.
After the tasting and lunch, we met with ESSKA President David Dejour for a nice walk in the city and we enjoyed some Caipirinhas in honor of his return from Brazil that morning. We had a great time talking with David about life in Lyon, its rich history, and of course, Trochleoplasty! On Monday, we were picked up by the hosts for a very busy OR day. We started the day with David in the morning and observed ACL reconstruction with LET, MPFL + TTO, Deflexion Osteotomy, and then Trochleoplasty with TTO... all before 11 AM! In the afternoon, we observed surgery with Jean Marie, who had several ACLs with lateral extra-articular procedure using his novel double bundle ALL technique. The day ended with dinner at the Brasserie Georges restaurant, which is the oldest and largest brasserie in Lyon. We had a great time at dinner, and also had the opportunity to celebrate Ned’s mock European “birthday”, complete with a song, champagne, and a sparkling ice cream cake! Sometimes, it pays to be the Godfather. The following day, we were in the OR with Dr. Elvire Servien and observed two MPFL reconstructions. Between these cases, we also had several case presentations on complex knee reconstruction and deformity correction.
Lyon is one of the most special places in Europe with a rich history both in the culture(cuisine),and also knee surgery (Lyon School of Knee Surgery). Amazing educational exchange took place, new friends were made, and Mary finally started to enjoy red wine! After lunch, we were picked up by our driver and departed to the airport to Paris for the 40th ESSKA Congress. Time for us to say“ Au Revoir” to Lyon.
The Final Stop - Paris
With our checked baggage already brimming with gifts, keepsakes, and the occasional dirty laundry, we boarded our last flight to Paris for the highly-anticipated ESSKA Congress, the first large in-person event in nearly 4 years. Situated in the “City of Light,” expectations and enthusiasm for educational content were at an all-time high, and the program did not disappoint. Dynamic speakers and innovative debates were all around us, and the Scientific chairs of Christophe Hulet, Kristian Samuellson, Martin Lind, and Geoffroy Nourrisat were all to be commended for their monumental efforts. We continued to be graciously welcomed at every turn as honored guests of ESSKA, and we were truly humbled to meet the giants of sports medicine and arthroscopy at the President’s reception, including Werner Muller, Niek Van Dijk, Rene Verdonk, Jacques Menetrey, and so many more. The denouement for our tour occurred at the Presidential Gala, where a cocktail reception, fine dining, dancing, and an Oscar-inspired “ESSKAR” award ceremony occurred. The room was bubbling over with energy, and we exchanged our final farewells with all our hosts, newfound colleagues, and friends before our trans-Atlantic flight early the next day.