AOSSM/ESSKA 2024 Traveling Fellows Tour

First Stop – Geneva, Switzerland

By Robby Westermann

The AOSSM-ESSKA 2024 travelling fellowship began in Geneva, Switzerland, where we were greeted by Jacques Menetrey upon arrival. We had an excellent pizza dinner and enjoyed the company of Professor Menetrey and Dr Victoria Duthon and their Italian fellow Andrea Pratobevera. We enjoyed reminiscing about Freddie Fu, Dr Safran and Prof Menetrey’s time training in Pittsburgh.

The next day, we joined Prof Menetrey, Dr Duthon and Dr. Greg Cunningham in the office observing evaluations and consultations with patients with complex knee and shoulder conditions. After an excellent morning discussing surgical indications and procedures, we broke for the afternoon and went for a run along the shore of Lake Geneva. In the evening, we had an academic session and shared ideas spanning biologics in orthopedics, novel ACL and cartilage restoration techniques, multi-ligament injuries, AC joint injuries and returning to sport after hip preservation surgery. This was followed by a classic Swiss dinner of Fondu sourced from local farms at the “best fondu restaurant in the world” -Prof Menetrey.

On Friday, we joined Prof Menetrey in the OR where he demonstrated arthroscopic techniques for postero-lateral rotatory instability after ACL surgery, ACL reconstruction using quad tendon autograft with LET augmentation and autograft chondrocyte implantation with their proprietary cartibeads. Dr Cunningham impressed us with a subscapularis preserving reverse shoulder arthroplasty and an all-suture technique for AC joint and CC ligament injury. Dr Bartolone demonstrated an outside-in approach to FAI with pincer and cam impingement cases. We then toured the Red Cross Museum and had a historic walk through Geneva learning the rich history of the Geneva Convention, the Red Cross, the United Nations and the history of Geneva dating back to 200BC.

Our final dinner in Switzerland overlooked Lake Geneva and was comprised of fresh fish, angus beef and generous gift exchanges.

On Saturday Morning Prof Menetery led us on a hike up Mont Salève for an unsurpassed view of Geneva, followed by an exchange of Swiss chocolates and we were off to Berlin.

Second Stop: Brandenburg, Germany

By Brian Lau

Saturday evening: After a short delay at the Zurich airport- we were met by our hosts in Berlin- Prof Sebastian Kopf and Prof, and current ESSKA president, Roland Becker. First stop was the autobahn from Berlin to Brandenburg. The traveling fellows and Godfather enjoyed traveling the fastest that any of us had ever been in a car. Upon safely arriving to the local pub - Kneipe Pur- the team worked their way through a selection of house brewed beers that paired with a classic German buffett of brats, sausages, cheeses, and soups. The night cap was a fine blue mouse whiskey.

Sunday was an active day taking in the local Brandenburg and Berlin sites. It started with a early morning running tour with Prof Becker and Kopf through the streets of Brandenburg. Next up was a rowing trip along the rivers of Brandenburg with the local rowing club. Rowing was a first time activity for godfather and all the traveling fellows and it started with an early lesson for Dr. Cvantovic’s hands. Once we got settled, it was a pictureperfect afternoon to enjoy the idyllic weather and breeze along the water.

Rowing was followed by lunch at the local restaurant to share a few drinks with some of the local cuisine. On the menu was delicious schnitztle and Zander fish from the Brandenburg river. From lunch, we were back on the autobahn to Berlin with a stop at the 1936 Olympic Stadium and the team took in the history of those games and the impact of Jesse Owen’s victories before the onset of World War II.

The tour then went from World War II to the Cold War- with a stop at Checkpoint Charlie which was one of the connections between East and West Germany. A tour through the museum highlighted the stories and struggles of Berliners during this time. The night finished with dinner atop the TV tower to take in the views from the highest point in the city on a revolving floor. The traveling fellows and Godfather enjoyed the stunning views of the city along with our dinner of local meats and cheese. After a stop at the Brandenburg Gate, our bellies and minds were full and ready for the next academic day.

Monday started in the operating room where the traveling fellows and Godfather were able to watch a rotator cuff repair and biceps tenodesis, and the implantation of chondrospheres, autograft cartilage implant technology not currently approved in the USA. Dr. Lau had the opportunity to scrub in to assist on a ACL and meniscus repair with Dr. Kopf. The OR was followed by our scientific program where Dr. Cvetanovich spoke on the management of anterior shoulder instability in athletes, and the other fellows and godfather held a symposium on

ACL tears. Dr. Safran spoke about management of partial ACL tears, Dr. Westermann on vancomycin and ACL surgery, and Dr. Lau on slope correcting osteotomy. There was an excellent exchange of ideas and techniques. Dinner was hosted at Dr. Becker’s house by his wife Gabriel. There was an excellent dinner and exchange of gifts for a fabulous time.

Tuesday’s program started in the operating room to see Dr. Becker perform a delicate MPFL reconstruction and a nice walk around Brandenburg, a city with its roots dating back to the 1100’s, where the godfather and

ESSKA president shared their years of wisdom to the fellows. Then it was off to the airport and to Barcelona.

Continuing On To Barcelona, Spain

by Greg Cvetanovich

After a smooth flight from Berlin to Barcelona, we were welcomed by warm temperatures and even warmer hospitality from our host, department chair, and ESSKA Vice President, Joan Carlos Monllau. We enjoyed a nice tapas dinner by Dr. Monllau and his team at Casa Carmen highlighting the Barcelona cuisine.

On the first full day in Barcelona, we had the privilege to join Dr. Monllau and his team including Carlos Torrens, Simone Perelli, Raul Torres-Claramunt for a robust and complex day in the OR at the Hospital de l’Esperança. Surgeries included open Latarjet procedure, reverse shoulder arthroplasty, high tibial osteotomy, fresh osteochondral allograft to the medial femoral condyle, and meniscal repair with bone grafting of widened tunnels from prior ACL reconstruction and lateral extraarticular tenodesis procedure.

After lunch, we had an engaging academic session addressing treatment options for massive and irreparable rotator cuff tears, meniscal repair and transplantation, as well as controversies in ACL reconstruction in the partial and revision settings. Next, Dr. Perelli led us on a tour of Barcelona City Centre, including historic sites and a stroll down the shopping and markets of La Rambla. The day concluded with a delicious dinner at Con Vador restaurant.

On the next day, we returned to the Hospital de l’Esperança for surgery including multiple revision ACL reconstruction procedures combined according to the pathology with concomitant procedures including deflexion osteotomy and lateral extraarticular tenodesis. Other surgery for the day included multiple tibial tubercle osteotomies and MPFL reconstructions, and lateral meniscal allograft transplantation. We had delicious lunch with tapas at La Panxa del Bisbe (Bishop’s belly) and then a quick siesta. We toured the

Casa Batllo where we witnessed the Gaudi architecture, and had a final dinner with our hosts at the Restaurant Monjuic el Xalet with an incredible hilltop view of downtown Barcelona after dark.

On Friday, we had time for a sunrise run and then said goodbye to Barcelona and went to the airport on for our flight to Oslo.

On To Oslo, Norway

By Robby Westermann

We arrived to Oslo and were greeted by our hosts, Berte Bøe and Lars Engebretsen at the airport and transferred to the Olympiatoppen Sportshotel, the Norwegian Olympic Training Center.

This is where we stayed while in Oslo, along with several Norwegian Olympic Athletes and Coaches. We were shown downtown Oslo by Gilbert Moatshe and Andres Persson and enjoyed discussions about practice differences and travelling fellowship differences across different societies.

On Saturday we began the day with an “in-depth” hospital screening / swabbing for visitors (to be sure Norway stays free of MRSA) and then were treated to an all-day academic program held near the Oslo Sports Trauma Research Center, led by Lars. We exchanged ideas about collection of patient-reported outcomes, ACL and hip registries, return to sport functional testing among other knee and shoulder research presentations. We were then welcomed to Berte’s home where we were served a feast of Reindeer and other classic Norwegian foods.

On Sunday, we started the day off with a brisk hike up the Vettakollen mountain with Berte and Sverre Loken. We experienced stunning views of Oslo, the Fjords and the skiing jumping facilities (Holmenkollen) despite some light rain and cool temperatures.

In the afternoon we partook in a traditional Nordic Sauna including wood-burning sauna baths and swimming in the Oslo Fjord (5-8 degrees C). And to top the day off, we were treated to a special dinner at Lars Engebretsen’s home with his wife, Britt, near the national soccer stadium.

On Monday, we were in the operating room and observed excellent cartilage repair for a displaced patellar osteochondral fragment, MPFL reconstructions, reverse shoulder arthroplasty, elbow arthroscopy, ankle arthroscopy, meniscal root repair and ACL and

revision surgical cases. We capped off the day with a wonderful feast at a waterfront restaurant near the Oslo Opera House (and where we had gone to the sauna the day before) with the Oslo team, including Berte, Lars, Gilbert, Andres and Sverre.

Tuesday was followed by further surgical observation including an arthroscopic Latarjet by Berte Bøe and an ACL reconstruction with meniscus repair. We enjoyed discussing advanced hip arthroscopy techniques with Kristian Warholm. After the abbreviated surgery day, we transferred to the Oslo airport and we were off to Luxembourg.

Next Stop: Luxembourg

By Brian Lau

The traveling fellows and godfather had a warm welcome at the airport by Prof Romain Seil and his wife Katy along with daughter Julie (a medical student in Frankfurt) and started our visit the with an elegant dinner in downtown Luxembourg.

The next day, the fellows and godfather celebrated May Day with a day of tours with our hosts. First was a tour of Edwards Steichen’s exhibit “The Family of Man” at Chateau de Clervaux to view his famous photographic display in the Northern part of Luxembourg. Next, there was trip into the Ardennes of Belgium to tour the Bastogne World War 2 Museum and learn about the Battle of the Bulge and the heroism of the American soldiers and citizens of Luxembourg and Belgium during the bloodiest battle of WW2. The night was capped by a delicious dinner with the team that featured traditional French dishes in a converted old school in a small town in the center of Luxembourg, Maison de Generations.

The next full day was filled with lots of cases. Lots of ACLs, LETs, meniscus repairs, and a distal femoral osteotomy. The team observed techniques including a ramp lesion repair and a medial closing wedge distal femoral osteotomy. The fellows and godfather were able to practice their new skills in a sawbones lab with Prof Seil to refine their osteotomy techniques. There was also a tour of the human performance and gait labs, as well as the ESSKA headquarters where they were able to meet the executive team, Zhanna Kovalchuk (Executive Director), Joseph Ramesh (Project Manager - Education), and several staff members of ESSKA and KSSTA, as they were getting ready for the upcoming ESSKA meeting in Milan. The night ended with an invigorating scientific session held at House 17, in the center of the old city of Luxembourg.

There was a great scientific exchange with participants from the local research team that discussed their novel ACL injury score, basic science research, and unique surgical techniques. Additionally, Henning Madri from the University of Saarland joined the scientific session and spoke about his work on Osteoarthritis and Cartilage. The fellows and godfather lectured on anterior instability, vancomycin and ACLs, ACL BEAR repairs, and hip microinstability. The night ended with a grand dinner with the whole Luxembourg team in the center part of the old city.

The next day started in the OR with an ACL/PCL and PLC and there was great discussion on different approaches. The last case was an ACL with medial and lateral meniscus repairs and an LET. That afternoon the team was treated to a walking tour of old town (over 1,000 years old) Luxembourg with the Luxembourg team and a former head nurse who is now a professional tour guide. We learned of Luxembourg’s rich history, as well as its recent history as a banking center of Europe, as well as an important part of the EU government, where the legal tribunal is housed. The night concluded with a wine tour and dinner with Prof Romain Seil, his wife Katy, and daughter Julie in the Sunnen Hoffmann organic vineyard at their picturesque town on the outskirts of Luxembourg along the Moselle River near the German border.

The final morning included a tour of the National Center of Sports and Culture where we were treated to a private tour of the Luxembourg Institute of High Performance Sports to learn of the new advances and approach to Olympic sports in Luxembourg.

The final stop was a visit to General Patton’s burial ground and the American Military Cemetery in remembrance of the sacrifices during World War 2, and particularly the Battle of the Bulge. The hospitality, exchange of ideas, research, and, most importantly, camaraderie was impressive. We were very appreciative of our visit as we move on to Lyon.

Penultimate Stop…Lyon, France

By Greg Cvetanovich

For our last stop of the AOSSM-ESSKA traveling fellowship prior to the ESSKA Meeting in Milan, we arrived in Lyon and were warmly greeted by our hosts, David Dejour and Elvire Servien. We made a quick change at the hotel into our “smart casual” costumes and went off to dinner with our hosts at the much-anticipated Paul Bocuse Restaurant. For over 50 years, this was rated in an exclusive group of three-star

Michelin restaurants in France, and the late Paul Bocuse was considered the father of French Cuisine and Lyon gastronomy. The dinner was incredible as was the conversation. The Godfather had a special Birthday celebration, complete with song and elaborate chocolate. The night ended with a guided tour of the kitchen and wine cellar, which traveling fellow Brian Lau observed was “really big.”

We awoke well-rested on Sunday and went for a run by the Rhône river and nearby park. Then we went to David Dejour’s country home for a delicious lunch barbecue and wine tasting organized by Guillaume Demey featuring selections from the nearby Burgundy, Rhône Valley, and Beaujolais regions.

After the meal, David Dejour gave the traveling fellows a tractor ride around the property. The godfather and fellows had a quiet evening exploring the Old Town of Lyon including Roman ruins and a walk up the hill to the Notre Dane cathedral in anticipation of a very busy Monday.

On Monday, David Dejour picked us up early for a busy OR day. Cases were fantastic, and the morning program featured a lateral patellar facetectomy, trochleoplasty with tibial tubercle osteotomy and MPFL reconstruction, deflexion osteotomy and revision ACL reconstruction and meniscal root repair, another trochleoplasty with MPFL reconstruction, and ACL reconstruction with lateral extraarticular tenodesis. And that was all before lunch and in 1 room. It was lunch time, so we grabbed a quick croissant to recharge for afternoon surgery. In the afternoon, we transferred across town to the Hopital Prive Jean Mermoz where we observed surgery with host Jean-Marie Fayard for a femoral physeal sparing pediatric ACL reconstruction with lateral extraarticular tenodesis, multiple ACL and ALL reconstructions with Santy technique, and MPFL reconstruction, as well as hip arthroscopy by Mathieu Thaunat and rotator cuff repair and Latarjet with the Santy surgical team.

After a busy surgery day, we gathered for our scientific presentations with presenters from the AOSSM Traveling Fellows and learned about the rich orthopaedic history in Lyon, including the Lyon School of Knee Surgery. The day ended with dinner at the Brasserie Georges restaurant, which is the oldest and largest brasserie in Lyon (founded in 1836 - 188 years old). We had a fantastic dinner, and again had the opportunity to celebrate Marc’s second “birthday” in three days, complete with a song, champagne, and a sparkling omelette à la norvégienne (Norwegian omelette, aka Baked Alaska) cake!

The following day was our last in Lyon, and we were in the OR with Elvire Servien and observed two ACL reconstructions with ALL reconstruction. Between these cases, we also discussed several case presentations on complex knee reconstruction with the team. After lunch, we departed to the airport to Milan for the ESSKA Congress.

The Final Stop – Milan, Italy

Each of us having traveled over 10,000 miles and an average 11 flights to get to this point, we are all amazed that our checked baggage never got lost or delayed. Our last flight, an 18 seat dual propeller plane with no overhead storage space or bathroom, carried us with our overloaded bags filled with gifts, keepsakes, and the last of our clean clothes (and the rest was dirty laundry for home), took us on a 1 hour flight from Lyon, France (the food capital of the world) to Milan, Italy (the fashion capital of the world) to attend the highly-anticipated ESSKA Congress – “Where Science Meets Art”. The ESSKA Congress was a phenomenal meeting, with its greatest attendance ever, at over 4,500 attendees. The scientific program was tremendous and hearty congratulations was well deserved for Martin Lind, Maristella Saccomanno and Thomas Tischer as program Chairs, Pietro Randelli the Congress President, and Roland Becker, ESSKA President. The meeting had something for everyone, with presidential lectures and guest lectures, and many highlight and keynote lectures from ESSKA members as well as international guests, and of course, ICLs, free papers and consensus symposia. The level of science and lectures was first rate.

As it was throughout the traveling fellowship, we continued to be graciously welcomed as honored guests of ESSKA. The traveling fellowship reception was special, as there were 2 other groups of traveling fellows in Europe at the same time as our tour. We got to meet with the SLARDESSKA traveling fellows, and the APKASS-ESSKA traveling fellows sharing their experiences with us. Additionally, we had the honor and pleasure to meet with our hosts again, as well as the other hosts for the other tours, and had the special honor of spending time with Werner Mueller, one of the founders of the traveling fellowship. Additionally, Dean Taylor, president of AOSSM, and Rainer Seibold, General Secretary for the Magellan Society were there to welcome all the traveling fellows to the Magellan Society.

Next, we were honored to share a wonderful dinner with a beautiful view of the Duomo with the AOSSM leadership - Dean and Anne Taylor, Kurt and Beth Spindler, Chris and Christine Kaeding, Ned and Alison Amendola, Peter Indelicato and Lisa Karch, and AOSSM CEO, Greg and Lynette Dummer.

And finally, we were treated to an unbelievable grand finale event - the Presidential Gala Dinner at Villa Necchi, where we were able to meet and mingle with the ESSKA leadership. We were able to tour the museum, as well as enjoy cocktails, a fine dinner, music and dancing, along with their classic ESSKAR awards – where Dean Taylor accepted the Best Partner Society award from ESSKA on behalf of the AOSSM.

As we bid our final farewells, we were left with the feeling this is just the beginning of a newer, stronger relationship between the AOSSM and ESSKA, as well as with our new friends, colleagues and wonderful hosts. We are grateful to be selected as representatives of the AOSSM to ESSKA and we are grateful to Enovis for sponsoring the traveling fellowship…it was a trip of a lifetime.