This year the Teach the Teacher course is held from 26-28 May in ASTC, National University Hospital, Singapore. The course is an intensive three day event to include lectures, debates and Cadaver workshops made possible by smith&nephew. The objective of the program is to build a group of connected surgeons dedicated to ankle arthroscopy. These surgeons are the (future) leaders in this field in their countries. The faculty for the course consists of Prof. Niek van Dijk, prof Jean Brilhault, prof Xu Dong MIAO and prof. Zhong Ming SHI.
The cycle for science tour Amsterdam - Barcelona 2016 is a fact! Cycling for science, in the defense of life. We will ride from Amsterdam to Barcelona and you are all invited to join!
The goal of this project is to raise funds to support research in the field of orthopedic sport medicine with focus on prevention of disease. The tour consists of eight stages, which brings the participants from the 2014 ESSKA hosting city, Amsterdam, to the 17th biannual ESSKA congress in Barcelona. During the tour in each city there will be a symposium with renowned speakers, charity dinners and auctions. Are you in?
For more information: www.cycleforscience.com.
Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):944-56. doi:10.1007/s00167-016-4059-4.
Golanó P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Götzens V, van Dijk CN.
Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar 26.
Identification of the superficial peroneal nerve : Anatomical study with surgical implications.
de Leeuw PA, Golanó P, Blankevoort L, Sierevelt IN, van Dijk CN.
PURPOSE:To prevent iatrogenic damage to the superficial peroneal nerve during ankle arthroscopy, it needs to be identified. The purpose of the present study was to determine which clinical test identified the superficial peroneal nerve most frequently and which determinants negatively affected the identification.
METHODS:A total of 198 ankles (99 volunteers) were examined for identification of the superficial peroneal nerve. Race, gender, body mass index (BMI), shoe size and frequency of physical activity were collected.
RESULTS:The best method to identify the superficial peroneal nerve was the maximal combined ankle plantar flexion and inversion test. In this position, the nerve was identified in 57 % of the ankles by palpation. BMI was the only independently influential factor in the identification of the superficial peroneal nerve.
CONCLUSION:Since in nearly six out of the ten ankles the superficial peroneal nerve can be identified, it is advised to assess its anatomy prior to portal placement. A higher BMI negatively influences the identification of the superficial peroneal nerve.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar 29.
Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay.
Dalmau-Pastor M, Yasui Y, Calder JD, Karlsson J, Kerkhoffs GM, Kennedy JG.
The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes reported. However, its anatomy has not been described in detail and only a few studies are available on this structure. The presence of a non-constant oblique supero-lateral band appears to be important. This structure defines whether the augmentation of the lateral ankle ligaments reconstruction is performed using true IER or only the anterior part of the sural fascia. It is concluded that the use of this structure will have an impact on the resulting ankle stability.
Our department received the accreditation as IOC Research Centerfor Prevention of Injury and Protection of Athlete Health. Only nine centers worldwide received this recognition. The IOC has chosen our Amsterdam Collaboration on Health & Safety in Sports (ACHSS), because we stand at the forefront of the sports medicine research. The ACHSS brings together the two teaching hospitals in Amsterdam, combining the two Dutch leading groups on research and practice on prevention and treatment in sports medicine. Within the ACHSS research focuses on the prevention and treatment of sports injuries in Olympic athletes in the broadest sense. We were honoured to receive the accreditation from professor Lars Engebretsen, head of the International Olympic Committee medical research.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar 18.
Calder JD, Freeman R, Domeij-Arverud E, van Dijk CN, Ackermann PW
PURPOSE: To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.
METHODS: Following a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.
RESULTS: 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4-0.8 %) and 1 % (95 % CI 0.2-1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8-18.2 %) and 10.5 % (95 % CI 5.0-15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 % (95 % CI 5.5-8.5 %) and radiological incidence of 35.3 % (95 % CI 26.4-44.3 %).
CONCLUSION: Isolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar 12.
Baltes TP, Zwiers R, Wiegerinck JI, van Dijk CN.
PURPOSE: The aim of this study was to systematically evaluate the available literature on surgical treatment for midportion Achilles tendinopathy and to provide an overview of the different surgical techniques.
METHODS: A systematic review of the literature available in MEDLINE, EMBASE and the Cochrane database of controlled trials was performed. The primary outcome measure in terms of patient satisfaction and the secondary outcome measures that consisted of complication rate, pain score, functional outcome score and success rate were evaluated. The Downs & Black checklist and the Coleman methodology scale were used to assess the methodological quality of included articles.
RESULTS: Of 1090 reviewed articles, 23 met the inclusion criteria. The included studies reported on the results of 1285 procedures in 1177 patients. The surgical techniques were divided into five categories. Eleven studies evaluated open surgical debridement, seven studies described minimally invasive procedures, three studies evaluated endoscopic procedures, one study evaluated open gastrocnemius lengthening, and one study reported on open autologous tendon transfer. Results regarding patient satisfaction (69-100 %) and complication rate (0-85.7 %) varied widely.
CONCLUSIONS: This study demonstrates the large variation in surgical techniques available for treatment of midportion Achilles tendinopathy. None of the included studies compared surgical intervention with nonsurgical or placebo intervention. Minimally invasive and endoscopic procedures yield lower complication rates with similar patient satisfaction in comparison with open procedures. Minimally invasive and endoscopic procedures might therefore prove to be the future of surgical treatment of Achilles midportion tendinopathy.
Knee Surg Sports Traumatol Arthrosc. 2016 Feb 4.
van Dijk CN, Longo UG, Loppini M, Florio P, Maltese L, Ciuffreda M, Denaro V.
PURPOSE: Correct management of syndesmotic injuries is mandatory to avoid scar tissue impingement, chronic instability, heterotopic ossification, or deformity of the ankle. The aim of the present study was to perform a systematic review of the current treatments of these injuries to identify the best non-surgical and surgical management for patients with acute isolated syndesmotic injuries.
METHODS: review of the literature was performed according to the PRISMA guidelines. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases was performed using the following keywords: "ankle injury", "syndesmotic injury", "chronic", "acute", "treatment", "conservative", "non-operative" "operative", "fixation", "osteosynthesis", "screw", "synostosis", "ligamentoplasties" over the years 1962-2015.
RESULTS: The literature search and cross-referencing resulted in a total of 345 references, of which 283 were rejected due to off-topic abstract and/or failure to fulfil the inclusion criteria. After reading the remaining full-text articles, we included four studies, describing non-surgical management, and only two studies investigating surgical management of acute isolated injuries.
CONCLUSIONS: the ESSKA-AFAS consensus panel provided recommendations to improve the management of patients with isolated acute syndesmotic injury in clinical practice. Non-surgical management is recommended for stable ankle lesions and includes: 3-week non-weight bearing, a below-the-knee cast, rest and ice, followed by proprioceptive exercises. Surgery is recommended for unstable lesions. Syndesmotic screw is recommended to achieve a temporary fixation of the mortise. Suture-button device can be considered a viable alternative to a positioning screw. Partial weight bearing is allowed 6 weeks after surgery.