Last update: September 8, 2014 

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August 2014


Knee Surg Sports Traumatol Arthrosc. 2014 Aug 8. 

Validation of the PASSPORT V2 training environment for arthroscopic skills.

Stunt JJ, Kerkhoffs GM, Horeman T, van Dijk CN, Tuijthof GJ.



Virtual reality simulators used in the education of orthopaedic residents often lack realistic haptic feedback. To solve this, the (Practice Arthroscopic Surgical Skills for Perfect Operative Real-life Treatment) PASSPORT simulator was developed, which was subjected to fundamental changes: improved realism and user interface. The purpose was to demonstrate its face and construct validity.


Thirty-one participants were divided into three groups having different levels of arthroscopic experience. Participants answered questions regarding general information and the outer appearance of the simulator for face validity. Construct validity was assessed with one standardized navigation task, which was timed. Face validity, educational value and user-friendliness were determined with two representative exercises and by asking participants to fill out the questionnaire. A value of 7 or greater was considered sufficient.


Construct validity was demonstrated between experts and novices. Median task time for the fifth trial was 55 s (range 17-139 s) for the novices, 33 s (range 17-59 s) for the intermediates, and 26 s (range 14-52 s) for the experts. Median task times of three trials were not significantly different between the novices and intermediates, and none of the trials between intermediates and experts. Face validity, educational value and user-friendliness were perceived as sufficient (median >7). The presence of realistic tactile feedback was considered the biggest asset of the simulator.


Proper preparation for arthroscopic operations will increase the quality of real-life surgery and patients' safety. The PASSPORT simulator can assist in achieving this, as it showed construct and face validity, and its physical nature offered adequate haptic feedback during training. This indicates that PASSPORT has potential to evolve as a valuable training modality.

J Foot Ankle Surg. 2014 Aug 13.

Comparison of Postinjection Protocols After Intratendinous Achilles Platelet-rich Plasma Injections: A Cadaveric Study. Wiegerinck JI, de Jonge S, de Jonge MC, Kerkhoffs GM, Verhaar J, van Dijk CN.


The purpose of the present investigation was to evaluate the distribution of intratendinous injected platelet-rich plasma (PRP) after 15 minutes of prone resting versus immediate manipulation simulating weightbearing.


Ten cadaveric lower limbs were injected under ultrasound guidance with PRP dyed with India blue ink. The dyed PRP was injected into the mid-portion of the Achilles tendon, after which 5 specimens were placed in the prone position for 15 minutes (simulating rest) and the remaining 5 specimens were manipulated through 100 cycles of ankle dorsiflexion and plantar flexion (simulating walking). Thereafter, the specimens were dissected, and the distribution of the India blue dye was ascertained.


In the simulated rest group, every specimen showed dyed PRP in the Achilles tendon and in the space between the paratenon and tendon. The median craniocaudal spread of the PRP was 140 (range 125 to 190) mm. In 4 of the simulated rest tendons (80%), the distribution of PRP extended across the entire transverse plane width of the tendon. In the simulated motion group, every specimen showed dyed PRP extending across the entire transverse plane width of the tendon and in the space between the paratenon and tendon. The median craniocaudal spread was 135 (range 115 to 117) mm. No statistically significant difference was found in the amount of craniocaudal spread between the simulated motion and rest groups.


In conclusion, it does not appear to matter whether the ankle has been moved through its range of motion or maintained stationary during the first 15 minutes after PRP injection into the mid-portion of the Achilles tendon. The precise meaning of this information in the clinical realm remains to be discerned.

July 2014

In Memoriam

Pau Golanó            (1965-2014)
Scientist, Artist and Teacher

It was a Saturday in April 2004: it was St Jordi day. In discotheque Luz de Gas at 4AM we were celebrating our first successful 2-day dissection course for my residents. We talked about life. "I will not get old" he said. And he looked serious, "another 10 years". Then we laughed and took another beer.

Pau Golanó died on 23 July, 2014. A massive stroke. Out of the blue, on the top of his career. So many plans, so many horizons to cross. Pau Golanó became 49 years old.

Pau was professor of Pathology and Experimental Therapeutics at the University of Barcelona. His exceptional anatomical dissection skills and passion for education was quickly recognized by the orthopaedic surgeons surrounding him. And it did not take long before his skills were recognized worldwide and he became the leading expert on orthopaedic anatomy of the last decade. He devoted his career and life to the education of orthopaedic surgeons, making them better doctors by teaching anatomy in the finest details. The door of his Department in Barcelona was always open.

Over the years he has written many inspiring papers on orthopaedic surgical anatomy. A great number of them were the result of the collaboration between Pau and our department. Once every 2 years we organized in Barcelona a dissection course for all the residents of our Department. We practiced all the open surgical approaches. Pau Golanó was our teacher. But Pau was a teacher for all orthopaedic surgeons. Together with the love of his life Celine, he enjoyed travelling the world, meeting friends and sharing his knowledge.

He was a scientist who devotes his energy to orthopaedics. Pau Golanó allowed us to be better doctors for our patients. In 2012 he won the KSSTA best Paper Award for "Anatomy of the Ankle Ligaments: a Pictoral Essay" (Golanó, P. et al (2010). KSSTA Journal, 18(5), 557-569)

And in May 2014 at our ESSKA congress in Amsterdam he was honoured with the prestigious ESSKA AWARD for Most Dedicated Individual ESSKA Member. This AWARD gave him the International recognition which he deserved. This recognition was very important for him.

Pau Golanó was a nonconformist. His unique strength was his artistic vision. He was not quickly satisfied with his achievements and created an extreme high standard for himself. No concessions! This made him sometimes collide with his environment who could not always understand or follow him. But he was an artist with always a smile. With his charm he was liked by all. He worked best under pressure. Deadlines were never met. And the projects and deadlines were piling up. He was at the top of his career. Projects in Qatar, Pittsburgh, Amsterdam and the ESSKA Academy were lying ahead. Although he was a team worker he worked on his own. An anatomist among Orthopods. Alone among many friends.

And his work became better and better. Always in search for new techniques and better ways to expose our inner world. He collaborated with surgeons worldwide. The interaction was always fruitful and many ideas were born in his lab. His favourite joint was the ankle joint. The recent publication of near 100 pieces of his artwork was a culmination of his skills. (van Dijk CN, Golanó P, Ankle Arthroscopy. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014) Each picture an example of his unsurpassed eye for detail and his skills to disclose the beauty of the human body. One of his contributions to the worlds literature is the rediscovery of the forgotten Rouvière-Canela ligament. Together with our PhD Peter de Leeuw he started working on this publication in 2006. It is ready to be submitted. Peter will defend his thesis later this year. Pau would have been there.

But his legacy will go on. The "Golanó`s" will now & then pop-up in future presentations all over the world. And you will recognize a Golanó when you see one.

An anatomist among orthopods. He was one of us!

We will miss him

Niek van Dijk


Arthroscopy 2014 Jul 9

The Posterior Impingement View: An Alternative Conventional Projection to Detect Bony Posterior Ankle Impingement

Wiegerinck JI, Vroemen JC, van Dongen TH, Sierevelt IN, Maas M, Dijk CN

The purpose of the current study was to clinically evaluate the diagnostic value of the new posterior impingement (PIM) view in the detection of an os trigonum, compared with the standard lateral view, using computed tomography (CT) as a reference standard.
Three observers, 2 experienced (orthopaedic surgeon and radiologist) and one inexperienced (resident), independently scored 142 radiographic images for the presence of an os trigonum. The diagnostic performance was assessed using the computed tomographic scan as the reference standard. Accuracy, sensitivity, specificity, positive predicted value (PPV), and negative predicted value (NPV) were calculated.
The PIM view had significantly superior accuracy compared with the lateral view for each observer: orthopaedic surgeon, PIM view = 90 versus lateral view = 75 (P = .013); radiologist, PIM view = 80 versus lateral view = 64 (P = .019); resident, PIM view = 90 versus lateral view = 79 (P = .039). The mean sensitivity and specificity of the lateral view for all observers was 50% and 81%, respectively. For the PIM view, this was 78% and 89%, respectively. The PPV was 50% for the lateral view and 70% for the PIM view. The NPV was 84% for the lateral view and 93% for the PIM view.
The PIM view has significantly superior diagnostic accuracy compared with the conventional lateral view in the detection of an os trigonum. In cases of symptomatic posterior ankle impingement, we advise that a PIM view be used instead of or in addition to the standard lateral view for detection of posterior talar pathologic conditions. LEVEL OF EVIDENCE: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied reference gold standard.

June 2014

The 14th Amsterdam Foot and Ankle Course is coming up soon. On the 19th and 20th of June, we will be happy to turn the Academic Medical Center Amsterdam into a course venue full of Cadaver Lab sessions, Lectures, Computer courses, Live surgery and much more. The faculty is ready and the preparations are in full swing.

We are looking forward to have you on June 19 and 20, Amsterdam, the Netherlands.



From June 4-7, the XII International Congress of the Asociación Argentina de Artroscopía (AAA) will take place in Buenos Aires, Argentina. The honorary president of Argentina 2014 is Dr. Miguel Ayerza and the president is Dr. Daniel Slullitel. The congress is in cooperation with the AAOSSM and the ESSKA.

Prof. C.N. van Dijk will be the Presidential Guest Speaker with a lecture on "Current and Future Dilemmas in Orthopaedics".
In addition, he will give the following lectures:
- "Ankle Instability"
- "What about tendoscopy in Achilles lesions?"
- "Achilles"
- "What to do when we fail in the treatment of an O.C. Lesion?"

For complete program Click Here

May 2014

Knee Surg Sports Traumatol Arthrosc. 2014 May 20

Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects.

Kerkhoffs GM, Reilingh ML, Gerards RM, de Leeuw PA

The purpose of this study was to describe the short-term clinical outcome of a new arthroscopic fixation technique for primary osteochondral talar defects: lift, drill, fill and fix (LDFF).

Seven patients underwent an arthroscopic LDFF surgery for osteochondral talar defects, the mean follow-up was 12 months (SD 0.6). Pre- and postoperative clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS) and the numeric rating scales (NRS) of pain at rest and during walking. Remodelling and bone ingrowth after LDFF were analysed on weight-bearing radiographs during follow-up.

In all patients, LDFF led to an improvement of the AOFAS and NRS of pain. The AOFAS significantly improved from 63 to 99 (p < 0.001). The NRS of pain at rest significantly improved from 2.9 to 0.1 (p = 0.004), and pain with walking significantly improved from 7.6 to 0.1 (p < 0.001). On the final radiographs, five of seven patients showed remodelling and bone ingrowth after LDFF.

The LDFF of an osteochondral talar defect appears to be a promising arthroscopic treatment option for primary talar osteochondral defects. Although the clinical and radiological results of 1-year follow-up are encouraging, more patients and longer follow-up are needed to draw any firm conclusions and determine whether the results stand the test of time.

From 22nd to the 25th of May 2014 the 87th Annual Meeting of the Japanese Orthopaedic Association (JOA) will be held at the Kobe Convention Center in Kobe, Japan. The conference will cover areas like Education for the young surgeons in the orthopedic industry, locomotive syndrome, regenerative medicine and tissue engineering in orthopedic, feasibility of cell therapy for cartilage injury, developing arthroscopic surgery for sports medicine, revision and primary total joint replacement, conventional and future strategies for limb joint surgery, spinal surgery, current state and future prospects of malignant bone tumors, current state and future prospects of fracture treatment, current state and future prospects of ACL reconstruction and other topics. 

Prof. C.N. van Dijk will give a lecture on Ankle arthroscopy: State of the art and future perspective

For the complete program click here

Knee Surg Sports Traumatol Arthrosc. 2014 May 8

Safety and efficiency of posterior arthroscopic ankle arthrodesis

Hendrickx RP, de Leeuw PA, Golano P, van Dijk CN, Kerkhoffs GM.

To study the safety and efficiency of posterior arthroscopic ankle arthrodesis.

Ten fresh-frozen human lower leg specimens without evidence of previous surgery to the foot and ankle were selected. Arthroscopic debridement of the tibiotalar joint was performed in all specimens using a standardized protocol. Anatomical dissections were regarded the gold standard for safety analysis. To evaluate the efficacy of the posterior ankle arthroscopic arthrodesis, the debrided articular tibiotalar parts were resected and subsequently analysed using Image-analysis software, Image J (Wayne Rasband, National Institutes of Health, Bethesda, MD).

In none of the specimens, iatrogenic damage was detected during the anatomical dissection following the posterior ankle arthroscopic procedure. A total talar joint surface area of 95 % and total tibial joint surface area of 96 % was addressed during the arthroscopic debridement.

The posterior ankle arthroscopic arthrodesis can be regarded safe and is also highly effective in the debridement of cartilage, resulting in optimal biology for fusion to occur. Therefore, this new arthroscopic technique potentially will diminish existing non-union rates for the fusion of the ankle joint.


Live surgical demonstration (AFAS) (10:30 - 11:30)
Hindfoot endoscopy, Os trigonum, retrograde drilling OCD, endoscopic groove deepening, subtalar arthrodesis
Prof. C.N. van Dijk

Free paper presentations: Foot, ankle & tendon (14.00-15.00)
14.10-14.15 - Treatment of apofysitis calcanei: A therapeutic randomized clinical trial
J.I. Wiegerinck

Symposium: Acute and chronic syndesmotic injury: a solution for everything (16:00 - 17:00)
16:00 - 16:12 - Diagnosis of syndesmotic injury: Delayed physical examination vs. US vs. MR
Prof. G.M.M.J Kerkhoffs
16:36 - 16:48 - Operative options for treatment of chronic syndesmotic injury.
Prof. C.N. van Dijk

Debate: Achilles tendon rupture (17.00-17.30)
17.00 - 17.30  - Follow the guidelines or just treat the patient?
Prof. C.N. van Dijk, D. Meuffels

ROOM: E 104-107
AOSSM Symposium: Acute injuries in athletes: A case based debate on treatment and return to play (17:15 - 18:00)
17:45 - 18:00 - Case III: Foot and ankle - Acute grade II-III syndesmosis injury.
Prof. C.N. van Dijk, Prof. N. Amendola

ROOM: G 106-107
Symposium: Ligament healing: State of the art (14:15 - 15:30)
14:59 - 15:10 - Clinical application: Healing of the lateral / medial ankle ligaments and the syndesmosis - State of the art
Prof. C.N. van Dijk


ROOM: G 104-105
ICL 04: Achilles tendon rupture treatment: still a weak spot? (7:30 - 08:55)
07:30 - 07:42  -  Presentation of Achilles tendon study group consensus book
08:06 - 08:18 -  Key elements of successful open surgery for primary Achilles tendon rupture
Prof. C.N. van Dijk

ROOM: G 102-103
Symposium: Primary talar OCD: What is new? (14:00 - 15:30)
14:00 - 14:15 -  Diagnostic work-up: MR vs. CT vs. US
M. Terra
14:45 - 15:00 -  LDFF procedure best practice, (not) only in children?
Prof. G.M.M.J Kerkhoffs
15:00 - 15:15 - Developments in debridement and drilling: healing water?
G. Tuijthof

Star Paper Session (10:30 - 12:00)
10:30 - 10:40 -  Metal resurfacing inlay implant for osteochondral defects of the talus after failed previous surgery: a prospective study.
C. van Bergen


ROOM G 106-107
ICL 11: Subchondral bone and reason for surgery (07:30 - 08:55)
08:38 - 08:55 -  How to treat subchondral bone pathologies in the ankle joint

FORTE resident programme: Ankle (14:30 - 15:30)
14:30 - 14:50 - Debridement and drilling vs chondrocyte transplant. 
Prof. C.N. van Dijk, F. Vannini
14:50 - 15:10 - Open vs scopic achilles tendon release
M. van Sterkenburg, U. Longo
15:10 - 15:30 - Open vs scopic ankle arthrodesis
Prof. G.M.M.J Kerkhoffs , T. Ogut


ROOM: G 106-107
Symposium: Injury in female soccer player (12:00 - 13:00)
12:00 - 12:10 - Ankle injury
Prof. G.M.M.J Kerkhoffs

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