Last update: December 17, 2014 

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December 2014

Foot Ankle Surg. 2014 Dec;20(4):241-7. doi: 10.1016/j.fas.2014.05.008. Epub 2014 Jun 9.

The impact of ankle osteoarthritis. The difference of opinion between patient and orthopedic surgeon.

Witteveen AG, Hofstad CJ, Breslau MJ, Blankevoort L, Kerkhoffs GM.

Outcome measures for ankle osteoarthritis (OA) are created by physicians with little input of the target patient group. The aim of this study was to determine the difference in opinion between patients and orthopedic surgeons concerning the importance of specific symptoms of ankle OA and its impact on daily life and function.
A modified Delphi method was applied, consisting of structured interviews with patient focus groups and experts, followed by a poll using 32 statements. The difference in opinion between patients and orthopedic surgeons was evaluated.
Forty patients and forty orthopedic surgeons responded to the 32 statements. Statistically significant differences in opinion on symptoms, function and the impact of ankle OA on daily life were found.
This study demonstrates a significant difference in opinion between patients and orthopedic surgeons concerning specific symptoms of ankle OA. These results advocate incorporating the needs and demands of the individual patient for new outcome measures.

The first Teach the Teacher ankle arthroscopy course in Hong Kong! The course will take place in the Prince of Wales hospital from 3 till 5 December 2014.


November 2014


Knee Surg Sports Traumatol Arthrosc. 2014 Nov 1.

Treatment of midportion Achilles tendinopathy: an evidence based overview.

Zwiers R, Wiegerinck JI, van Dijk CN


In Achilles tendinopathy, differentiation should be made between paratendinopathy, insertional- and midportion Achilles tendinopathy. Midportion Achilles tendinopathy is clinically characterized by a combination of pain and swelling at the affected site, with impaired performance as an important consequence. The treatment of midportion Achilles tendinopathy contains both non-surgical and surgical options. Eccentric exercise has shown to be an effective treatment modality. Promising results are demonstrated for extracorporeal shockwave therapy. In terms of the surgical treatment of midportion Achilles tendinopathy, no definite recommendations can be made.


Acta Orthop. 2014 Oct 28:1-7.


Comparison of optical coherence tomography and histopathology in quantitative assessment of goat talus articular cartilage.

Cernohorsky P, Kok AC, Bruin DM, Brandt MJ, Faber DJ, Tuijthof GJ, Kerkhoffs GM, Strackee SD, van Leeuwen TG.


Background and purpose:
Optical coherence tomography (OCT) is a light-based imaging technique suitable for depiction of thin tissue layers such as articular cartilage. Quantification of results and direct comparison with a reference standard is needed to confirm the role of OCT in cartilage evaluation.

Materials and methods:
Goat talus articular cartilage repair was assessed quantitatively with OCT and compared with histopathology using semi-automated analysis software. Osteochondral defects were created centrally in goat tali with subsequent healing over 24 weeks. After sacrifice, the tali were analyzed using OCT and processed into histopathology slides. Cartilage thickness, repair tissue area, and surface roughness were measured. Also, light attenuation coefficient measurements were performed to assess differences in the properties of healthy tissue and repair tissue.

Intra-class correlation coefficients for resemblance between the 2 techniques were 0.95 (p < 0.001) for thickness, 0.73 (p = 0.002) for repair tissue area, and 0.63 (p = 0.015) for surface roughness. Light attenuation differed significantly between healthy cartilage (8.2 (SD 3.9) mm-1) and repair tissue (2.8 (SD 1.5) mm-1) (p < 0.001).

Compared to histopathology as the standard reference method, OCT is a reproducible technique in quantitative analysis of goat talus articular cartilage, especially when assessing cartilage thickness and to a lesser extent when measuring repair tissue area and surface roughness. Moreover, differences in local light attenuation suggest measurable variation in tissue structure, enhancing the clinical applicability of quantitative measurements from cartilage OCT images.

October 2014

The Australian Orthopaedic Association (AOA) organizes the 2014 Annual Scientific Meeting from 12-16 October in Melbourne, Australia. The theme of this meeting is ‘Orthopaedic Advances in the 21st Century - What's the Evidence?'

Prof. dr. C. Niek van Dijk will give three Instructional Course Lectures on Thursday the 16th of October:
- "Endoscopic treatment of the Achillies tendon" (8.00 - 8.30 a.m.)
- "Anterior and posterior ankle arthroscopy" (1.30 - 2.00 p.m.)
- "The rational for the diagnosis and treatment of talar OCD" (3.30-4.00 p.m.)

More information is available on the website.

September 2014

PhD Thesis: "The Achilles Heel of Adults and Children" by Jan Joost Wiegerinck.

Promotor: Prof. dr. C.N. van Dijk, co-promotores: Prof. dr. G.M.M.J. Kerkhoffs and dr. P.A.A. Struijs. October 1 2014, 1.00 p.m. Aula UvA, Singel 411, Amsterdam.

This thesis focuses on the imaging and treatment of the Achilles heel of adults and children. The figurative and literal Achilles heel consists of a number of pathologies: ankle impingement, Achilles tendinopathy, retrocalcaneal bursitis and calcaneal apophysitis. The aim of the thesis is to clearly describe the structures and pathologies leading to complaints in the region of the Achilles tendon, furthermore conventional radiologic imaging techniques of this region are evaluated as well as the treatment of adults and children who are impaired by the aforementioned disorders.

Click here to read the thesis.

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


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