News & Press

From the ESSKA Under 45 Committee

Mon, 16 Dec 2024 13:46:00 GMT

“If you ask 100 people for their opinion, you will get 110 opinions.”

Antonio Klasan, Riccardo Compagnoni, Elmar Hrbst, Mahmut Enes Kayaalp, Daniel Perez Prieto, Alberto Grassi

Contribution from the U-45 Committee

If one talks to colleagues who do anterior cruciate ligament (ACL) reconstruction, typically the discussion is around graft choice and fixation methods. The evidence does not favor one over the other, rather, some grafts work better in some patients [10, 11], and therefore, an a-la-carte approach is recommended. The graft fixation angle, unless over-the-top technique is performed [14], is pretty much clear, full extension or up to 30° due to the biomechanical properties of the ACL in anatomical position of the tunnels [1, 7].

It becomes more interesting when lateral extra-articular procedures (LEAP) are considered. Initially, LEAP was controversial both as a concept and in relation to the anterolateral ligament (ALL) itself. However, it is becoming increasingly common in both primary and revision ACL surgeries [8]. While the role of LEAP in revision ACL surgeries is mostly adopted for a relevant number of patients [6], its application in primary ACL surgeries is still under debate [5], and has been thus the matter of a recent Consensus Meeting among Experts. When it comes to surgical technique, the majority of surgeons would adopt a modified Lemaire procedure, taking a strip of the IT-band, pull it under the lateral collateral ligament (LCL) and fix it back to the femur slightly proximal and posterior to the lateral epicondyle. This procedure does not exactly recreate an anatomical structure, and rather entails the “plastic” modification of an existing structure on the lateral aspect of the knee, with the aim to better control the rotational laxity and the lateral compartment translation.

This brings up the question of the appropriate flexion angle for fixing the LEAP, particularly in the commonly used modified Lemaire procedure, where the tibial attachment of the iliotibial band (ITB) is maintained.

If you ask around, the most common responses will be around 30°, always more than for an ACL, with the foot in neutral rotation. But, if one looks at the literature in more detail, it becomes more interesting. A recent meta-analysis partially reveals just how wide the flexion span for LEAP is – ranging between 0° and 90° [9]. In fact, more patients were fixed at high flexion angles, >60° than at low flexion angles <30°. The authors excluded flexion angles between 30 and 60°, although studies fixing the LEAP at 45° do exist as well [2, 3].

There is also no difference in clinical outcomes between high and low flexion angles, and no difference in graft rupture rate [9]. In fact, although the modified Lemaire procedure is often considered an isometric reconstruction, the strip of ITB wraps around LCL when near full extension. Therefore, the term "isometric" may be questionable. If the Lemaire fixation is performed at a higher flexion angle, the fulcrum around the LCL might be different compared to fixation at a lower flexion angle. Consequently, the restraint of anterolateral rotation could be slightly enhanced when the ITB strip is fixed at higher flexion angles. However, these considerations have not been scientifically proven.

How is such a wide range possible without seemingly any impact whatsoever? The graft is non-isometric, unless the isometric point on the femur is identified prior to fixation, which is, again, non-anatomical. This means that, in theory, either over-tensioning or under-tensioning could occur, depending on the angle of fixation. Over-tensioning can be clinically evident if the graft is fixed in flexion, leading to a noticeable restriction in extension, whereas under-tensioning might be less immediately apparent.

It's challenging to claim that all fixation angles for a non-isometric construct yield the same clinical outcomes without raising further questions. What exactly are we achieving with these procedures? Could the tightened closure of ITB, after removing a portion, play a more significant role than we might like to acknowledge? Additionally, what is the influence of the Kaplan fibers in these scenarios? These factors warrant deeper investigation to understand their potential impact on surgical outcomes.[12]?

We should delve deeper into these topics through both biomechanical research, including finite element analyses, and clinical studies. Until such investigations are conducted, there will continue to be as many opinions as there are surgeons—in other words, 110 opinions for 100 surgeons—and everyone will consider themselves correct.

Abdel Khalik H, Lameire DL, Kay J, Tapasvi SR, Samuelsson K, de Sa D (2022) Both low and high knee flexion angles during tibial graft fixation yield comparable outcomes following ACL reconstruction with quadriceps tendon autograft: A systematic review. J ISAKOS 7(3):24–32
Alm L, Drenck TC, Frosch K-H, Akoto R (2020) Lateral extra-articular tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior knee instability. Knee 27(5):1451–1457
Behrendt P, Fahlbusch H, Akoto R, Thürig G, Frings J, Herbst E, Raschke MJ, Frosch K-H, Kittl C, Krause M (2023) Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction. Orthop J Sports Med 11(5):23259671231166380
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223(4):321–328
Getgood A (2022) Editorial Commentary: Indications for Lateral Extra-Articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction. Arthroscopy 38(1):125–127
Grassi A, Olivieri Huerta RA, Lucidi GA, Agostinone P, Dal Fabbro G, Pagano A, Tischer T, Zaffagnini S (2024) A Lateral Extra-articular Procedure Reduces the Failure Rate of Revision Anterior Cruciate Ligament Reconstruction Surgery Without Increasing Complications: A Systematic Review and Meta-analysis. Am J Sports Med 52(4):1098–1108
Hammarstedt JE, Guth JJ, Schimoler PJ, Kharlamov A, Miller MC, Akhavan S, Demeo PJ (2023) Biomechanical Analysis of Ideal Knee Flexion Angle for ACL Graft Tensioning Utilizing Multiple Femoral and Tibial Tunnel Locations. J Knee Surg 36(3):298–304
Hollyer I, Sholtis C, Loughran G, Raji Y, Akhtar M, Smith PA, Musahl V, Verdonk PCM, Sonnery-Cottet B, Getgood A, Sherman SL, ACL Study Group (2024) Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016-2023, an ACL Study Group Survey. J ISAKOSDOI: 10.1016/j.jisako.2024.100356
Kolin DA, Apostolakos J, Fabricant PD, Jivanelli B, Yen Y-M, Kramer DE, Kocher MS, Pennock AT, Nepple JJ, Willimon SC, Perkins CA, Ellis HB, Wilson PL, McClincy M, Everett Voos J, Spence DD, Heyworth BE (2024) Knee Flexion Angle of Fixation During Anterolateral Ligament Reconstruction or Lateral Extra-articular Tenodesis: A Systematic Review and Meta-analysis of Lateral Extra-articular Reinforcement Techniques Performed in Conjunction With ACL Reconstruction. Orthop J Sports Med 12(2):23259671241231254
Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E (2019) Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Outcomes for Quadriceps Tendon Autograft Versus Bone-Patellar Tendon-Bone and Hamstring-Tendon Autografts. Am J Sports Med 47(14):3531–3540
Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ (2017) Hamstring Autograft versus Patellar Tendon Autograft for ACL Reconstruction: Is There a Difference in Graft Failure Rate? A Meta-analysis of 47,613 Patients. Clin Orthop Relat Res 475(10):2459–2468
Sayac G, Goimard A, Klasan A, Putnis S, Bergandi F, Farizon F, Philippot R, Neri T (2021) The anatomy of Kaplan fibers. Arch Orthop Trauma Surg 141(3):447–454
Wieser K, Fürnstahl P, Carrillo F, Fucentese SF, Vlachopoulos L (2017) Assessment of the Isometry of the Anterolateral Ligament in a 3-Dimensional Weight-Bearing Computed Tomography Simulation. Arthroscopy 33(5):1016–1023
Zaffagnini S, Lucidi GA, Macchiarola L, Agostinone P, Neri MP, Marcacci M, Grassi A (2023) The 25-year experience of over-the-top ACL reconstruction plus extra-articular lateral tenodesis with hamstring tendon grafts: the story so far. J Exp Orthop 10(1):36

Artificial Intelligence in Orthopaedic Research

Wed, 13 Mar 2024 11:36:00 GMT

The Landscape of Proprietary and Open-source Large Language Models with Potential Applications in Orthopaedic Research

Authors: Bálint Zsidai1,2, Jacob Oeding3, Ayoosh Pareek4, Robert Feldt5, Kristian Samuelsson1,2,6.

¹ Sahlgrenska Sports Medicine Center, Gothenburg, Sweden
² Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
³ School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, U.S.A.
⁴Sports and Shoulder Service, Hospital for Special Surgery, New York, NY, USA
⁵Department of Computer Science and Engineering, Chalmers University of Technology, Gothenburg, Sweden
⁶ Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

Introduction

The recent year has sparked an increasing interest in the application of large language models (LLM) to medical research. The broad spectrum of use cases for LLMs in medicine is illustrated by recent noteworthy publications, featuring AI systems with superior performance in differential diagnostics [2], as well as clinical history-taking and empathetic diagnostic dialogue [5] compared with human physicians. Furthermore, different LLMs have shown variable capability to make evidence-based clinical decisions based on specific and complex guidelines across several medical specialties [6]. While the implementation of LLMs in orthopaedics is currently limited, recent work published by the ESSKA Artificial Intelligence Working Group aims to introduce researchers in orthopaedics to the potential of domain-specific applications of artificial intelligence (AI) and generative models [7]. A recent study highlights the potentially transformative role of LLMs in question-answering for orthopaedic care [1]. Expanding on this capability, there is an increasing tendency towards the integration of multimodal [4], expert-annotated data [8], including medical images, electronic health records and biomedical data into AI systems, with the promise of providing efficient and accurate clinical decision-support in clinical settings. However, the scope, complexity, and potential societal impact of LLMs raises concern with regards to ethical barriers and the regulatory oversight required for safe and reliable implementation in healthcare systems [3].

The majority of orthopaedic researchers may be familiar with LLMs such as the Genetive Pre-trained Transformer (GPT) 4, popularized by Open AI’s ChatGPT platform and Microsoft’s Bing Chat. However, ongoing developments in the field of generative text models are pioneered by several additional stakeholders, both in the proprietary and open-source domains. The aim of this article is to highlight some of the most popular proprietary and open-source LLMs in 2024 that may serve as viable tools for orthopaedic applications (Table 1).

Proprietary vs. Open-source LLMs

While proprietary LLMs are owned by companies and have restrictions on their usage, they may offer better performance and security compared to open-source models. The main advantage of proprietary LLMs is their superior performance and security compared to open-source models. Furthermore, closed-source LLMs may be more suitable for specific tasks or industries. In addition to restricted user access and control, ethical concerns and higher economic cost of proprietary LLMs are further barriers to entry for their use in orthopaedic research and clinical applications.

In contrast, open-source LLMs are freely accessible and offer transparency and flexibility. The transparency of the model arcarchitecture and the dataset it was trained on is desirable from the perspective of reproducible and ethical academic research. In contrast to proprietary models, open-source LLMs offer a lower economic barrier to entry and superior adaptability to specific use cases. Their development relies on community-driven development and innovation. Consequently, open-source LLMs may not offer comparable levels of performance to proprietary counterparts for the general user, and may require additional technical proficiency for adaptability and training for research applications in orthopaedics. Additional potential risks include data privacy concerns, "hallucinations" and misinformation generated by the models.

At the time of this writing open-source models are gaining in popularity due to their performance improvements. While proprietary models may still have the edge in terms of general ease-of-use, open-source may be equal or superior options when fine-tuned to specific tasks. Consequently, the choice between the two approaches currently hinges on the desired level of customization, resources and technical proficiency to ensure effective use, as well as the balance between cost and potential security concerns.

Table 1: An overview of popular proprietary and open-source LLMs (CITE PAPERS)

Proprietary	Open-source
GPT 4.0 Developer: OpenAI Features:	LLaMA 2 Developer: Meta Features:
1.76 trillion parameters Can handle multimodal input data (text and images) Improved performance in the comprehension of longer documents or mixed text input compared with predecessors Can directly be fine-tuned to align with specific use-cases	Models ranging from 7 to 70 billion parameters. Pre-trained on public and refined based on human-annotated data Fine-tuning performed with supervised learning and reinforcement learning techniques.
Claude 2 Developer: Anthropic Features:	Falcon Developer: TII Features:
12 billion parameters. Smaller model size favors auditability and safety over scale Excellent performance with chain-of-thought prompting to generate logical and trustworthy text in niche contexts.	Available in two versions with 7 and 40 billion parameters, Falcon 7-B and Falcon 40-B. Trained on high-quality, curated dataset scraped from the web. Use a multi-query attention technique to improve model inference.
PaLM 2 Developer: Google Features:	Dolly 2.0 Developer: Databricks Features:
340 billion parameters Fine-tuned and adapted for superior and rapid performance compared with predecessor. Enhanced capability to understand subjective and figurative expressions. Serves as a foundation for domain-specific models such as Med-PaLM, which is developed for medical question-answering.	12 billion parameters Trained and finetuned with instruction/response record data from the company. Excellent performance in following instructions.
Gemini Developer: Google Features:	BLOOM Developer: BigScience Features:
6 billion to 540 billion parameters. Trained with multimodal reasoning in mind. Excellent performance in complex tasks such as mathematic and computer programming	176 billion parameters. Generates content in several natural and computer languages that is indistinguishable from human-created content. Can be prompted to perform summarization, question-answering and information extraction tasks.

Conclusion

In conclusion, one of the main goals of the ESSKA Artificial Intelligence Working Group in 2024 will be to underscore and explore the domain-specific application generative AI. While the growing popularity of open-source LLMs accredited to performance improvements, transparency, and flexibility cannot be ignored, proprietary models remain more accessible alternatives due limited technical proficiency to fine-tune open-source models to orthopaedic applications. Finally, the balance between cost and security considerations will further shape the future adoption of LLMs for orthopaedic research and clinical applications.

References
1. Kaarre J, Feldt R, Keeling LE, Dadoo S, Zsidai B, Hughes JD, et al. (2023) Exploring the potential of ChatGPT as a supplementary tool for providing orthopaedic information. Knee Surg Sports Traumatol Arthrosc 31:5190-5198
2. McDuff D, Schaekermann M, Tu T, Palepu A, Wang A, Garrison J, et al. (2023) Towards accurate differential diagnosis with large language models. arXiv preprint arXiv:2312.00164
3. Meskó B, Topol EJ (2023) The imperative for regulatory oversight of large language models (or generative AI) in healthcare. npj Digital Medicine 6:120
4. Topol EJ (2023) As artificial intelligence goes multimodal, medical applications multiply. Science 381:adk6139
5. Tu T, Palepu A, Schaekermann M, Saab K, Freyberg J, Tanno R, et al. (2024) Towards Conversational Diagnostic AI. arXiv preprint arXiv:2401.05654
6. Vaid A, Lampert J, Lee J, Sawant A, Apakama D, Sakhuja A, et al. (2024) Generative Large Language Models are autonomous practitioners of evidence-based medicine. arXiv preprint arXiv:2401.02851
7. Zsidai B, Hilkert AS, Kaarre J, Narup E, Senorski EH, Grassi A, et al. (2023) A practical guide to the implementation of AI in orthopaedic research - part 1: opportunities in clinical application and overcoming existing challenges. J Exp Orthop 10:117
8. Zsidai B, Kaarre J, Hilkert AS, Narup E, Senorski EH, Grassi A, et al. (2023) Accelerated evidence synthesis in orthopaedics-the roles of natural language processing, expert annotation and large language models. J Exp Orthop 10:99

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U45 Shoulder Survey

Tue, 6 Feb 2024 13:31:00 GMT

U45 Committee Shoulder Survey.

Irreparable rotator cuff tears are disabling pathologies which have severe impact on patients’ autonomy and daily life activities especially when young and active subjects are involved. This issue is still debated, the precise definition uncertain, the different clinical presentations not completely classified, and the choice of the different surgical options not categorized. According to all these aspects the ESSKA U45 Committee developed a survey in the attempt to raise an accepted approach to diagnosis and treatment of the different clinical situations. The survey, which was uploaded on the ESSKA website, was based on 25 questions. The first 7 questions approached general demographic information for each surgeon (country, age, gender, work, number of cuff repairs and reverse shoulder arthroplasties performed each year). The following 7 questions were focused on general aspects of the pathology such as the criteria to define a massive cuff tear as “irreparable”, and indication for specific surgical procedures described in the literature (such as tendon transfers, balloon spacer, patches). Specific clinical scenarios were then given, and the next five questions were focused on the preferred treatment approach to any of these clinical scenarios of irreparable anterior and posterior-superior cuff tears in young patients. The final 5 questions were referred to the same clinical scenarios affecting old patients. Fifty-seven people completed the questionnaire. Most of the participants were French and males (90%). From the survey emerged that almost half of the participants (45.6%) performed more than 75 cuff repairs each year, 68.4% performed less than 30 shoulder replacements and 91% performed less than 10 tendon transfers each year confirming that cuff repair is much more frequent than shoulder replacement and even more than tendon transfers in daily practice. When dealing with general aspects, fatty degeneration was the most common criteria to define a massive cuff tear as irreparable (59.6%) (Fig.1), the age threshold to define a young patient was 55-60 years for 40.4% of the participants and physical therapy was the first option of a conservative approach for 61.4% of the participants.

Biceps tenotomy/tenodesis was the treatment of choice for 67.9% of the surgeons when arthroscopic repair was not considered an option (Fig.2).

Superior capsule reconstruction with long head of biceps was indicated by 50.1% of the participants to increase a pathologic acromio-humeral distance (Fig.3) and protect the cuff.

The indication for latissimus dorsi transfer or lower trapezius transfer was external rotation with the arm at side + external rotation at 90° of abduction lag (hornblower sign) in 39.2% of the participants. Tendon transfers were performed in isolated fashion in case of irreparable cuff tear in 36% of the cases. Three clinical scenarios were given for massive irreparable postero-superior cuff tears for young and old patients: external rotation with the arm at side lag (supraspinatus and infraspinatus tears) (Fig.4), external rotation with the arm at side + external rotation at 90° of abduction lag (supraspinatus, infraspinatus and teres minor tear) without pseudoparalysis and external rotation with the arm at side + external rotation at 90° of abduction lag + pseudoparalysis.

In young patients, regarding the first scenario, the most common surgical option was partial repair of the cuff (41.8%), regarding the second the most common answer was partial suture of the cuff + latissimus dorsi or lower trapezius transfer (39.3%) and regarding the third scenario the most common answer was partial suture of the cuff + latissimus dorsi or lower trapezius transfer (25.5%). When the same questions were referred to old patients the most common answers were: reverse prosthesis (49.1%), reverse prosthesis (44.6%) and reverse prosthesis +/-latissimus dorsi or lower trapezius transfer (44.6%) respectively. Two scenarios were given for irreparable anterior-superior cuff tears in young and old patients: irreparable anterosuperior cuff tear (clear subscapularis lag) with and without pseudoparalysis. Partial repair of the subscapularis was the treatment of choice in young patients with irreparable anterosuperior cuff tear (clear subscapularis lag) without pseudoparalysis (40%), while pectoralis major was indicated in case of irreparable anterosuperior cuff tear (clear subscapularis lag) with pseudoparalysis (34.6%). In old patients, reverse shoulder prosthesis was indicated in the same scenarios by 44.6% and 68.4% of the participants. Finally, age under 50 years was considered the threshold to propose a reverse prosthesis for 25% of the surgeons while 25% of them did not have any age threshold.

Conclusion

Although the present survey had some limitations (low response rate, the majority of the participants from a single country and extremely specific argument), it was a critical approach widely discussed aspect of shoulder pathology. We do believe that the attempt to provide clear clinical scenarios and specific surgical options for each of them may be extremely useful in daily practice to standardize the decision-making. Biologic options (partial cuff repairs, tendon transfers and superior capsule reconstruction with biceps) emerged as the reference in case of young patients with deficient cuff (both posterior and anterior). Reverse shoulder prosthesis was indeed the most common treatment option in old patients.

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The Power of Teamwork: Establishing a Rehabilitation Committee in ESSKA

Mon, 27 Nov 2023 07:06:00 GMT

Robert Prill

Aleksandra Królikowska

Eric Hamrin Senorski

On behalf of the ESSKA Rehabilitation Committee

Rehabilitation essentially contributes to the clinical practice of orthopaedics, traumatology and sports medicine. In recent years, strong and effective cooperation between these healthcare stakeholders has been considered mandatory. ESSKA therefore recently introduced a Rehabilitation Committee to ensure patients’ interprofessional needs are addressed sufficiently. Responsibility for leading this newly established committee has been entrusted to Dr Prill from Germany. Apart from the chairman, the Rehabilitation Committee comprises ten members from Sweden, Poland, the Netherlands, Iceland, France, Denmark, Norway, Italy, the United States and Abu Dhabi.

The composition of the healthcare team taking care of a patient in the fields of orthopaedics, traumatology and sports medicine varies depending on the condition of the patient and the type and stage of treatment. The multidisciplinary, multi-professional team comprises medical doctors, physiotherapists, nurses, and, if needed, training and medical staff taking care of athletes and occupational therapists, clinical psychologists, orthotists, prosthetists, and social workers. The team also includes the patient and their family. To be beneficial, decision-making should involve all stakeholders. One future task of the Rehabilitation Committee will be to better identify when shared decision-making is of value in the treatment process.

The entire healthcare team has the same goal: to improve the physical condition and psychological adaptation of patients according to their (realistic) expectations and needs. To achieve this, the patient's expectations must be known, accepted and addressed by each team member during the entire healthcare process. This is especially true for orthopaedic surgeons and physical therapists, as they are the crucial professional contacts for patients. If orthopaedic surgeons develop realistic patient expectations and goals with the patient prior to surgery, the physical therapist will be able to use those goals over the long-term follow-up to develop adequate rehabilitation protocols, motivate the patient and evaluate their progress.

When different stakeholders in the ‘patient’s team’ use the same information, the patient’s confidence in the team and the treatment methods increases. This is fundamental for building the patient's trust in the team and the treatment programme. A common example is when a medical doctor and physiotherapist provide a patient with different information about the period crutches or braces will be required for walking following meniscus surgery. Considering the discrepancies reported in the literature, both the doctor and the physiotherapist are likely to work in accordance with evidence, but the different opinions and suggestions may result in the patient losing trust in the team. It is therefore essential for the medical team to prepare an evidence-informed joint statement for such patients. However, how can a broadly accepted joint statement be achieved? Most members of the Rehabilitation Committee are involved to some extent in the current and ongoing Formal EU–US Meniscus Rehabilitation Consensus: An ESSKA–AOSSM–AASPT Initiative. Given the release of two impactful ESSKA consensus projects on the treatment of degenerative meniscus lesions or acute meniscus tears from a surgical point of view^{1, 2}, it is now time for consensus on rehabilitation for these conditions.

The goal of this consensus, on which ESSKA, the American Orthopaedic Society for Sports Medicine (AOSSM), and the American Academy of Sports Physical Therapy (AASPT) are working together, is to provide recommendations regarding the use of rehabilitation for patients undergoing either non-surgical or surgical treatment for degenerative meniscus lesions or acute meniscus tears.

ESSKA consensus projects are powerful tools that harmonize evidence and clinician opinions and thus patient treatment. The involvement of surgeons and rehabilitation specialists is therefore necessary for better outcomes when treating orthopaedic patients. The Rehabilitation Committee members are ensuring multidisciplinary, multi-professional collaboration by working with the ESSKA section European Knee Associates (EKA) on a strategic project to increase activity and return patients to sports after degenerative knee surgery. Further projects are also currently being discussed with ESMA, ESA and AFAS. In addition to the expertise gained in their learned profession, healthcare team members should generally know the primary issues that their colleagues deal with and be able to use them in the treatment process. It is therefore beneficial that the activities organised by ESSKA will include sessions devoted to both orthopaedics and physical therapy, as this will allow specialists representing different professions to gain knowledge in these disciplines.

We are confident that the Rehabilitation Committee and its close collaboration with the ESSKA sections and committees will help increase the impact of ESSKA in improving the treatment of patients in orthopaedics, traumatology and sports medicine. It’s time for collaboration and real transdisciplinary treatment!

Let’s do it!

References
1. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2017;25:335-46.
2. Kopf S, Beaufils P, Hirschmann MT, Rotigliano N, Ollivier M, Pereira H, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2020;28:1177-94.

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ESSKA U45 Committee: How ChatGPT will revolutionize Orthopaedic Practice

Tue, 26 Sep 2023 07:53:00 GMT

Unveiling the Future of Orthopaedic Practice: How ChatGPT is Revolutionizing Clinical, Surgical, and Research Landscape the Next Years.

The advent of large language models, exemplified by ChatGPT, promises to revolutionize the landscape of orthopaedic clinical, surgical, and research practices in 2024¹. With its ability to generate responses akin to human communication, ChatGPT emerges as an invaluable asset within the realm of healthcare applications. Its versatility shines as it assumes the role of a virtual assistant, streamlining tasks like appointment scheduling and health information management for patients. However, its impact goes far beyond administrative duties².

For orthopaedic surgeons, ChatGPT offers a dynamic toolset that goes beyond mere assistance. By harnessing real-time data and evidence-based insights, it provides surgeons with recommendations that bolster surgical techniques and practices. Moreover, ChatGPT's proficiency extends to transcribing dictations from doctors and nurses, efficiently summarizing crucial patient details, encompassing everything from symptoms to diagnoses and treatment plans.

The utility of ChatGPT expands into the realms of documentation as well. It is instrumental in crafting comprehensive surgical notes and reports, encompassing procedures such as meniscus repair, bankart repair, ACL reconstruction, and rotator cuff repair. While templates serve as a foundation, they are tailored to each operation's unique intricacies, ensuring accurate representation.

In a world increasingly connected by technology, patients are no longer constrained by geographical boundaries when seeking medical expertise³. Telemedicine has facilitated cross-border consultations, but language barriers have persisted as a challenge. Interpreting medical reports and scans across languages has historically required time-consuming and costly translation or re-reporting. Enter ChatGPT, which assumes the role of a real-time translator, seamlessly converting reports into the clinician's native language. This breakthrough not only accelerates communication during emergencies on foreign soil but also holds the potential to save lives. Likewise, patients can leverage the same tool to comprehend medical reports in their mother tongue, promoting better understanding and informed decision-making.

The integration of ChatGPT in the realm of medical research heralds a transformative approach to constructing research protocols. Leveraging its advanced language generation capabilities, ChatGPT serves as an innovative tool for designing comprehensive and precise research frameworks. Researchers can interact with the model to articulate their study objectives, variables, methodologies, and anticipated outcomes. Through dynamic exchanges, ChatGPT aids in refining the protocol's structure, enhancing its clarity and coherence. This collaborative process not only expedites protocol development but also ensures that research parameters are meticulously defined.

Despite their remarkable potential, it's important to acknowledge that large language models do come with inherent limitations within the clinical, surgical, and research contexts. While ChatGPT and its counterparts can assist in patient communication, they do not replace the personalised care and empathy that healthcare professionals provide. In surgical planning, while they can offer valuable insights, these models lack the hands-on experience and intuition that surgeons possess. In research, while they can aid in generating protocols, they cannot replicate the creative thinking, critical analysis, and domain expertise that researchers bring to the table. Moreover, concerns surrounding data privacy, bias, and the need for validation of generated content remain pertinent challenges. As such, while large language models offer transformative possibilities, they should be viewed as tools that complement and enhance human expertise, rather than replace it.

In essence, as we stand on the cusp of 2024, the assimilation of large language models like ChatGPT into orthopaedic clinical, surgical, and research practices promises to reshape the landscape of healthcare delivery. With its ability to mimic human-like interactions and offer valuable insights, this AI innovation stands as a testament to the potential of technology to advance the field and elevate patient care to unprecedented heights.

References

1. Dahmen J, Kayaalp ME, Winkler PW, Ollivier M, Pareek A, Karlsson J, Hirschmann MT. Intelligent innovations for our journal's path forward. Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1185-1186. doi: 10.1007/s00167-023-07354-7. Epub 2023 Feb 21. PMID: 36809508.
2. Ollivier M, Pareek A, Dahmen J, Kayaalp ME, Winkler PW, Hirschmann MT, Karlsson J. A deeper dive into ChatGPT: history, use and future perspectives for orthopaedic research. Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1190-1192. doi: 10.1007/s00167-023-07372-5. Epub 2023 Mar 9. PMID: 36894785.
3. Dahmen J, Kayaalp ME, Ollivier M, Pareek A, Hirschmann MT, Karlsson J, Winkler PW. Artificial intelligence bot ChatGPT in medical research: the potential game changer as a double-edged sword. Knee Surg Sports Traumatol Arthrosc. 2023 Apr;31(4):1187-1189. doi: 10.1007/s00167-023-07355-6. Epub 2023 Feb 21. PMID: 36809511.

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How can effective communication help optimize your writing process and your chance to get published?

Wed, 26 Apr 2023 09:00:00 GMT

Caroline Mouton¹

Robert Prill²

¹ESSKA Basic Science Committee Chairwoman
²ESSKA Basic Science Committee Member

A scientific paper where research findings and clinical relevance are not intelligible enough is likely to be rejected. From the authors’ perspective, such rejection can be frustrating, as writing and preparing a manuscript according to the individual journal requirements is a lengthy process. However, from the reviewers,’ editors,’ and future readers’ perspective, reading a paper which requires much effort to understand is frustrating too.

The reality is that scientific writing requires skills far beyond the fundamental knowledge of how to structure a paper. While the latter aspect is largely developed in existing guidelines, there are still few guidelines on how to effectively communicate ideas. This would however be of help to authors for accelerating their writing process and ensuring the readers’ comprehension, thus optimizing their chance to get published. This article aims to give some fundamentals for effective communication in scientific writing.

1. Effective communication

Effective communication involves capturing the attention, ensuring the message is understood and encouraging the readers to use the information, may it be remembering it or applying it. In scientific writing, information is the answer to the question "What are the results of the study?" and the message is the clinical relevance and the answer to the question "How can the findings be useful to my peers?".

Minimizing the effort of the reader, through facilitating reading and understanding of the paper, is a key point for effective communication. Readers expect fluid reading. They want to understand and be convinced about the content and the value of a paper effortlessly and rapidly. This is impossible if the paper lacks clarity, cohesion, and conciseness, something common in the manuscripts reviewers receive.

A second key point for effective communication is to be continuously aware of the main message. Many authors write without having clarified their own thoughts and without a guiding thread. This usually leads to papers where the reader gets lost in details and too much information and where the bigger picture (main message) is absent.

2. Logical flow

A logical flow of ideas is crucial to ensure the smooth progression of a scientific paper and will enhance the presentation of the message. It can be described by asking the question: What are the main topics to define in each section of the paper and in which order?

An effective way to ensure a logical flow ahead of writing is to explain the study to a peer and ask to repeat the information. In such a situation, many of us naturally present the main context before going into the details and limit the information to what is necessary, which helps comprehension. If the peer is not able to return the information and main message, this may highlight a weakness in the logical flow (e.g., missing information) which should be corrected. At the end, this process helps to accurately define the different paragraphs of the future paper and to write it in a more efficient and rapid way.

3. Structure and logical flow in scientific papers

Scientific papers should be seen as a whole story where the logical flow in the text and main sections enhance the presentation of the main findings and message.

The introduction aims to justify the need and originality of the study. It is constructed as an inverted pyramid where information is given from the more general to the more specific. Too general knowledge or literature review should be avoided due to the specialized audience (i.e., there is no need to explain that arthritis is a common disease). If properly done, the first paragraphs are sufficient for the reader to guess the general aim of the study.

The material and methods section presents the study experiments step by step. It must be exhaustive enough to allow any reader to reproduce the experiments. Write it as a cooking recipe where you expect to have all ingredients and the right order to mix them.

Writing the results section should start by drafting figures and tables to present the main outcome(s). In the text, a brief statement about the main finding(s) to remember is then enough, and the repetition of the entire tables or figures should be avoided. Proceeding like this ensures that the main finding remains the focus.

The discussion is an upright pyramid where information is given from the more specific to the more general, starting with a sentence like: “The primary finding of this study was…”. Each result should be discussed in separate paragraphs including their interpretation, relevance, what they add to the literature, how they can fill a gap in previous knowledge and how they can be used. Reviewers' opposition may be anticipated and arguments to refute them may be included.

4. Paragraph and sentence structure

Generally, each paragraph and sentence should develop only one idea and should start with what is known. Added information (additional, more complex) should come next.

A well-structured paragraph starts with a sentence identifying its main argument to provide a clue about its content. Then, definitions, confrontation with available evidence, and interpretation are provided. Finally, a sentence to reemphasize the idea or to prepare the next idea closes the paragraph.

Appropriate transitions between the ideas are crucial to lead the reader through a clear message throughout the manuscript. Enumerating information is insufficient to convince a reader about the importance of a study. Beyond a certain point, more information indeed results in less understanding.

5. Title, abstract, figures and tables

The title, abstract, figures and tables must be considered as stand-alone pieces as they are often read or disseminated separately e.g., on social networks. They should be the first parts of a manuscript to write and should also be carefully checked again before submission.

The title should already inform about the paper content and attract people to read it. Both, the title and the abstract should explicitly highlight the message the reader should remember.

Figures and tables should be easy to read and help to understand the full story without reading the text. Visualization should be used to point out the vital information (i.e., labels, arrows) but should be limited to avoid distraction (i.e., reduce numbers, digits after coma, lines, or forms). The legend should be a description of the content and the main findings of the figure / table.

6. Proofreading

Ensuring clarity, cohesion and conciseness should be continuous work. Any change in a sentence requires reading the entire paragraph again to ensure cohesion (e.g., consistency in tense and terms, style). The same applies to the entire manuscript after revisions to guarantee high quality work and optimize chances to get accepted. Even though there are always many people involved in a manuscript, the contribution of different authors should not be apparent at the end.

The goal before submitting a paper is to provide an effortless reading. Even if they are peers, readers may not understand complex terms or sentences nor do they like ambiguity or vague terms.

Co-author's/reviewers’ incomprehension should be considered to improve the paper. There is a reason people do not understand what may seem obvious; most of the time it is because the idea is poorly expressed.

Clarity

Unusual or complicated terms are systematically defined
Names that readers can effortlessly keep track of are favoured
Vague terms have been removed
Negations and double negations are avoided
Logical flow/outline can be (re)written from the first sentences of the paragraphs
Transition between sentences and paragraphs indicate the relation between ideas

Cohesion

Same word is used consistently to describe the same thing
Key concepts are repeated to emphasize the message and act as a guiding thread for the entire paper
Primary outcomes/findings are presented first in the methods, and subsequently in results, and discussion
Methods, results, main findings, and conclusions answer the objectives in a consistent way

Conciseness

Information is limited to what is necessary
Sentences and paragraphs are as short as possible without redundant information
Sentences are not longer than 20-25 words
Information not needed to support has been removed

Finally, it is important to accept that a manuscript will never be written in one draft. It can take a while to organize ideas logically and understandably even for the more experienced authors. It requires revising the manuscript on several occasions. The only secret is to keep training for effective communication, so it starts to become automatic.

We hope that following all these tips will help you achieve a solid piece of writing that will help you to get your manuscript accepted.

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U45 Committee Interviews Gilles Walch, the mentor who trained a generation of shoulder surgeons

Thu, 30 Mar 2023 06:30:00 GMT

Shoulder surgery has evolved more than other domains of orthopaedic practice in the last 30 years (1). Dr. Gilles Walch has been a pioneer in such a field since the end of the end of the 80s and, in cooperation with other talented surgeons, has enormously raised the standard in the diagnosis and treatment of shoulder pathologies. Traditional concepts such as anatomy and biomechanics have been revisited leading to huge innovations. The three main fields such as shoulder instability, rotator cuff pathology and shoulder replacement have become extremely common. Bone block procedures such as the Latarjet procedure, have a substantial role in the treatment of shoulder instability.

Dr. Walch’s interest in anterior traumatic shoulder instability mainly focused on the Latarjet procedure which has become the golden standard in cases of instability associated with bone loss. Thanks to his tireless activity, the Latarjet procedure has been accepted even in those countries where open or arthroscopic soft tissue procedures were the only treatment option. His scientific and critical approach even to his own results as well as his willingness to honestly discuss indications and results of surgical operations have widely influenced young orthopedic surgeons in decision-making. In addition, his anatomic studies have revolutionized shoulder replacement surgery with the development of new implants. More recently he worked on the evolution of digital planning and navigation systems leading to its spread in shoulder replacement surgery.

Finally, the paper by Servien and Walch on the outcomes of posterior bone block in posterior shoulder instability published in KSSTA was particularly relevant as it was one of the first homogeneous series analyzed at a robust FU (2) leading to renewed interest on this pathology.

As a result, the U45 Committee interviewed Dr. Walch for his unique role in this field.

Dr. Gilles Walch
Centre Orthopedique Santy · Shoulder Department | Lyon, France

U45: Dr. Walch, one of your main interests is the treatment of anterior and posterior shoulder instability. You published dozens of studies on the results of the Latarjet procedure and posterior bone block surgery and therefore you are considered one of the references of these procedures. However, in general these operations are somehow considered non-anatomic and not updated. Interestingly the overall number of bone block procedures and mainly Latarjet is increasing every year, even in those countries (i.e. USA) where capsular reinsertion was considered the gold standard. What is in your opinion on that?

GW: First, we should distinguish between anterior and posterior instability. Historically, in cases of anterior instability, arthroscopic soft tissue procedures did not show outstanding results with high recurrence rates especially in cases of bone loss. Bone block procedures have good outcomes and low recurrence rates even in high-risk patients. Moreover, the development of the arthroscopic Latarjet procedure by Lafosse has increased the interest in this procedure. Since the outcomes and complications of open and arthroscopic Latarjet are similar, the choice is really a matter of the surgeon’s preference (3). Regarding posterior instability there is limited data in the literature. I started with open bone block since it is what has been taught in the Department of my mentor Prof. Dejour. With the development of arthroscopic techniques, the arthroscopic iliac bone graft is now reliable and associated with good results. The publications by Godeneche have demonstrated that the arthroscopic technique should be considered the first option in the treatment of posterior instability (4).

U45: In the past decades you carried out several studies on the anatomy of the proximal humerus and the glenoid and the implication of anatomic parameters in the development of shoulder pathology. You also have proposed a classification for glenoid wear in shoulder arthritis which is well accepted. You started your experience with the anatomy, moving then toward the different open and arthroscopic techniques. Surgical techniques and instrumentations are fascinating for young surgeons even more than basics aspects of orthopaedics. What can you suggest to them?

GW: The anatomy is the basis for every surgeon. Its knowledge, as well as other general aspects such as biomechanics, physiology and biology should be an important part of everyone’s practice. In addition, every surgeon should be aware of the history of orthopaedics. Critically analyzing the pros and cons of the different operations as well as the results (positive or not) is helpful. In the past, some surgical operations have led to unsuccessful outcomes. One should try to analyze the reasons for such results rather than give in to temptation to rediscover them just to indulge the ego.

U45: You developed a system for planning shoulder arthroplasty procedure. Do you think robotic surgery will have the same influence on the shoulder as it is having on the knee and hip given the unique anatomic and biomechanics properties?

GW: I am sure it will have the same impact in the future even if it is not the case now. This is mainly an economic problem. Shoulder replacement surgery is at least ten years behind hip and knee, with the overall surgical volume being less relevant than other major joints. This is a problem for big companies because the robot is expensive, and the expected income hardly covers the expenses to develop these new technologies. Even if the shoulder is complex and has wide anatomic variability the preoperative planning with the aid of the computer is already on the market and has proven to be reliable. In addition, some companies are already advanced on the path towards developing a system for a robotic implantation of the glenoid component according to the preoperative planning with Blueprint.

U45: You have been a reference for shoulder surgery pushing the evolution of the major fields such instability, cuff repair and shoulder replacement with your relevant studies. What do you expect in the next future?

GW: I think we can expect huge progression in all these domains thanks to the 3D and digital technology. Regarding shoulder replacement, the preoperative planning and the robot in the operating room will help surgeons in achieving more accurate and reliable implant positioning. The digital technology will help in the instability domain as well as help in the precise evaluation of the bone loss. We will be able to correlate mid-term and long-term outcomes with the preoperative pattern of bone loss thanks to the artificial intelligence. Therefore, this technology will suggest the best treatment option for the specific anatomic damage of each patient. It’s all a matter of collecting precise data which will be analyzed by the artificial intelligence. Regarding cuff pathology, we are now able to assess the involvement of specific tendons, as well as tear patterns and extension of the tear and the fatty infiltration of the different muscles. With the aid of the artificial intelligence, we will be able to correlate these preoperative data with postoperative ones at different FU. At the end we will be able to choose for a specific patient (according to gender, age, level of activity) and for a specific damage (extent of the tear, pattern, fatty infiltration) the best treatment option (which kind of repair, need for patch augmentation, tendon transfer or reverse prosthesis).

References
(1) Zuckerman JD. Innovation in shoulder surgery: the impact on our patients. J Shoulder Elbow Surg. 2019 Feb;28(2):396-398. doi: 10.1016/j.jse.2018.02.078.
(2) Servien E, Walch G, Cortes ZE, Edwards TB, O'Connor DP. Posterior bone block procedure for posterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1130-6. doi: 10.1007/s00167-007-0316-x.
(3) Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T. The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy. 2007 Nov;23(11):1242.e1-5. doi:10.1016/j.arthro.2007.06.008.
(4) Métais P, Grimberg J, Clavert P, Kouvalchouk JF, Sirveaux F, Nourissat G, Garret J, Mansat P, Godenèche A; French Arthroscopy Society. Posterior shoulder instability managed by arthroscopic acromial pediculated bone-block. Technique. Orthop Traumatol Surg Res. 2017 Dec;103(8S):S203-S206. doi:10.1016/j.otsr.2017.09.001.

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U45 Committee interviews Steven Claes, the researcher who changed how many practice

Wed, 28 Dec 2022 13:07:00 GMT

Outcomes following anterior cruciate ligament (ACL) reconstruction are generally satisfactory, however, many patients do not regain pre-injury sporting levels and some even suffer persistent symptoms. There have been important scientific landmarks in orthopaedic surgery over the last five years to improve outcomes. The Under 45 (U45) Committee recently published a survey amongst ESSKA members under the ages of 45 to evaluate the recent evolutions in ACL surgery [1].

The survey was available on the ESSKA website and accessible to all members under the age of 45, which is a total of 1,035 members involved in multiple aspects of Orthopaedic practice. One hundred and forty questionnaires were returned. Several aspects of ACL surgery were investigated at baseline and five years prior. They included general details such as the volume of ACL reconstructions per surgeon per year, the graft choice in cases of low and high demanding patients, the technique for femoral tunnel drilling and the preferred device for femoral fixation. The approach to the management of damage to peripheral structures, including meniscal ramp and root tears, were also investigated.

One significant evolution amongst young surgeons was the use of extra-articular procedures (ALL reconstruction/lateral tenodesis) in patients undergoing ACL reconstructive surgery. On further analysis of the reasons for this increasing trend, we considered the work on the “rediscovery” of the anterolateral ligament (ALL) published by Steven Claes et al some 10 years ago [2].

This initial anatomical study lead to over a thousand further publications in the last decade alone and was responsible for the ongoing debate between those for and against the “ALL” with more than 40 editorials published on this very hot topic.

As a result, the U45 Committee interviewed Dr. Steven Claes for his insight on the evolution.

Dr. Steven Claes
Ortho Herentals | Herentals, Belgium

U45: Dr Steven Claes, you were involved in the last consensus statement regarding the role of the anterolateral ligament/complex in ACL deficient knees. Could you summarize the main points of the consensus and explain how you apply it to your daily practice.
SC: The goal of the consensus was to gather a comprehensive overview of ALL anatomy, function, biomechanics [3]. At that time, it was important to integrate the existing knowledge and bring it to a consensus, as before, lots of definitions, names and anatomical descriptions were used by the experts and it became quite confusing. Our discussion helped clean up the field for a better understanding for our orthopedic community. At the consensus meeting, most of the global key opinion leaders (KOLs) in “ACL” were present, and we actually learned a lot from that interesting collaboration.

Regarding my Practice: it didn’t change much. Since I was of course involved from the very beginning of the ALL story, the consensus statement was not a really big ‘eye-opener’ for me personally. The real “aha-erlebnis” occurred already in 2010 when I dissected my first ALL. I actually think for most of the KOLs involved in this consensus, the changes in their practice had already happened with the knowledge they gained regarding the ALL along the way.

U45: Steven, in late 2000s, you were at the beginning of the ALL story => how did you imagine such an anatomical study (published in JOA full name of the journal) and what were the elements that drove through this fantastic research project?
SC: I think our long standing experience with Lemaire surgery in Belgium really paved the way. We always had lots of ACL surgeons regularly performing a LET in Belgium, France and Italy, since the late 70s…and ITB surgery was very popular for decades in many countries, and so also in the one I was trained in. It has always fascinated me as to why that practice was so successful, when it was not really responding to any published anatomical structure…The second element was surely my fascination with the Segond fracture; I have always wondered why the role of a tibial plateau avulsion fracture at the lateral side of the knee, was only to function as pathognomonic for an ACL injury deep inside the joint.

The combination of the presence of a Segond fracture and the success ITB based procedures made me believe that there was something laterally that might explain everything. My initial idea when doing my PhD with Peter Verdonk in Gent was to work on ACL graft healing; later on with Johan Bellemans I got involved in a project on kinematic analysis after double bundle ACLR which was still popular in the late 2000s. Our findings clearly indicated that rotational control (pivot shift) was not sufficiently controlled with either single bundle or double bundle reconstructions, and that something was lacking in order to fix this rotational instability. ACL reconstructive surgery alone apparently was not sufficient to control the pivot shift.

I still remember the first knee I dissected in search of a ligament at the Segond locus: it was the best ALL I ever dissected. I am sure that if the dissection wasn’t so clear in this knee, then all the rest probably would have never happened. I called my boss in total excitement and I said well “I found something at the lateral side of the knee which might be the missing element we are looking for…”

We then set up a large cadaveric study for which I dissected around 40 knees for the first study (Image 1). I can safely say that the lateral anatomy of the knee has no secrets anymore for me, but still I remember this initial feeling and this first knee. Then afterwards everything went relatively easy and straight forward… the ligament has always been there for centuries, waiting to be characterized. After these dissections, we deliberately slowed down the publication in order to complete my whole PhD project including the radiological and biomechanical data on the ALL, but everything was almost done for the anatomical standpoint in 2011.

U45: What was the impact of those findings in your research life and your surgical career?
SC:Lots of good and some of bad things happened to me then. For the good parts it brought me lots of friends, I travelled the world to show my research and I am very proud to have become sort of a KOL for soft tissue surgery around the knee probably because of this research paper.

At the same time, we received a lot of attention from popular media outlets, which had never been a purpose. As a consequence, things took quite a political turn and some of the established colleagues and institutions became very aggressive with us. I think I was just a bit young and not really prepared to get smashed on podiums and very negatively criticized by some of my peers. Anyway, we succeeded in getting out of the storm, and after some years restraining myself from travelling, not saying anything about ALL to avoid conflicts, my life returned to normal…

As a surgeon here in Belgium, things ran slightly different though as nobody (except fellow surgeons) seem to know much about the ALL story, and I honestly think most of my patients don’t really care.

U45: What do you think is going to be the next big thing in sports medicine research?
SC: Very good question, and of course I don’t know exactly, although I have some interests. Regarding the ALL story, it really taught us to pay great attention to the peripheral structures and secondary restraints for the ACL like ALL, ramp, lateral meniscal root etc. I am convinced that the knowledge on these “ACL’s helpers” will continue to grow.

Personally, I hope for a breakthrough in the understanding of ACL-R biological healing factors. Human basic science research on the ins and outs of a successful ligamentization process after ACL graft implantation is still largely lacking. Finally, there are also a lot of things to improve for the rehabilitation of knee injuries, with still not too much evidence in that interesting field, as well as a long road to travel to prevent primary ACL injury and potential reruptures…

U45: Thanks you Steven for this interview and thanks for your milestone research around knee injury. We do believe that you have changed the fate (and revision risk) of thousands and thousands patients undergoing ACL reconstruction.
SC: Thanks for this most rewarding compliment, but in all modesty I am sure that also without me this story would have happened anyhow, with the words of Victor Hugo in mind that “no army can stop an idea whose time has come”.

Image 1: Cadaveric dissection of a right knee exhibiting position of the Anterolateral ligament.

References
[1] Cerciello S, Ollivier M, Kocaoglu B, Khakha RS, Seil R; ESSKA U45 Committee. ACL surgical trends evolve in the last five years for young European surgeons: results of the survey among the U45 ESSKA members. Knee Surg Sports Traumatol Arthrosc. 2022 Jun 14. doi: 10.1007/s00167-022-07005-3. Epub ahead of print. PMID: 35699743.
[2] Anatomy of the anterolateral ligament of the knee. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. J Anat. 2013 Oct;223(4):321-8. doi: 10.1111/joa.12087. Epub 2013 Aug 1.
[3] Getgood A, Brown C, Lording T, Amis A, Claes S, Geeslin A, Musahl V; ALC Consensus Group. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):166-176. doi: 10.1007/s00167-018-5072-6. Epub 2018 Jul 25. PMID: 30046994.
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Elbow and Wrist Committee develop dry elbow arthroscopy model

Thu, 11 Jun 2020 10:47:42 GMT

For the past two years the 𝗘𝗹𝗯𝗼𝘄 𝗮𝗻𝗱 𝗪𝗿𝗶𝘀𝘁 𝗖𝗼𝗺𝗺𝗶𝘁𝘁𝗲𝗲 of ESSKA has been developing, together with Sawbone, a dry elbow arthroscopy model. The team is pleased to finally present the final product. We invite everyone to give it a try at the Milan Congress in 2021 under the guidance of the committee.

Congrats to the Committee on their achievement!