Last update: February 27, 2015

Latest News

January 2015

A new chapter MTP-1 Arthroscopy has been added to the book on surgical techniques. Please go to the index to find out which chapters are online at the moment and to view the future chapters.

December 2014


Knee Surg Sports Traumatol Arthrosc. 2014 Dec 25.

Validity and reliability of a Dutch version of the Foot and Ankle Ability Measure.

Weel H, Zwiers R, Azim D, Sierevelt IN, Haverkamp D, van Dijk CN, Kerkhoffs GM.

The aim of the study was to develop a Dutch language version of the Foot and Ankle Ability Measure (FAAM) and evaluate its measurement properties according to the consensus-based standards for the selection of health measurement instruments (COSMIN) definitions.
A forward-backward translation procedure was performed and subsequently the Dutch version of the FAAM was evaluated for its reliability and validity in 369 patients with a variety of foot and ankle complaints. The reliability was assessed by calculating the intraclass correlation coefficients (ICC, test-retest reliability), Cronbach's alpha (internal consistency), the standard error of measurement and the minimal detectable change (MDC). Additionally, this was done for athletes. The construct validity was assessed by the use of Spearman's correlation coefficient between FAAM domains and similar and contradictory domains of the Foot and Ankle Outcome Score, Short Form 36 and the Numeric Rating Scale for pain.
The ICC of the subscales ranged from 0.62 to 0.86. Cronbach's alpha's minimum was 0.97. At individual level, the MDC ranged from 23.9 to 44.7 and at group level from 2.77 to 4.32. In the subgroup of athletes, the reliability was higher. The hypothesized correlations of the construct validity were supported by an 80 % confirmation rate.
The Dutch version of the FAAM met adequate measurement properties, although the reliability is not optimal. The FAAM-Sport subscale is more useful in athletes and the FAAM-Sport % seems not to contribute. In athletes with various foot and ankle symptoms, the FAAM can be used for functional assessment and follow-up at group level. For the general population, the FAAM is less appropriate.

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.

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