Fellow Laurie A. Hiemstra, MD
Banff Sports Medicine, Banff, Canada
Fellow Shital N Parikh, MD
Cincinnati Children’s Hospital, Cincinnati, USA

Lyon, France (Oct 6-Oct 8, 2014) 


Our traveling fellowship started in Lyon, France’s second-largest city which is immersed in rich historical and cultural tradition. On Oct 6 morning, Dr. David Dejour picked us up from the hotel and we headed straight to the operating room. The day was packed with 8 surgeries, back and forth between 2 operating rooms and 2 very efficient surgical teams. The surgical cases included patellofemoral arthroplasty, salvage trochleoplasty, MPFL reconstruction and tibial tubercle distalization. The sad part was that there was no time for lunch. The evening dinner was hosted by Dr. Dejour at Brasserie Leon de Lyon with Professor Elvire Servien, Dr. Guillaume Demey and a visiting fellow. On Oct 7, we visited the Albert Trillat Center at University Hospital, where we were greeted by Professor Philippe Neyret and Professor Servien. It was wonderful for Professor Servien to present the ‘History of French Orthopaedics’ with brief introduction of the pioneers of patellofemoral surgery. The morning session ended with case discussions. That afternoon gave us some free time to hike up the ‘Fourviere’ and the ‘Roman ruins’. The morning of Oct 8 was again spent with Dr. Dejour in the operating room where we had chance to discuss some cases, interact with him and get more surgical perspective on the patellofemoral joint. 


Tampere, Southern Finland (Oct 9-Oct 11, 2014) 


Tampere has been dubbed as the ‘Manchester of Finland’ for its industrial past. Dr. Petri Sillanpaa, picked us up from the hotel on the morning of Oct 9 and we headed to ‘Kirurgian Koulutuskeskus’, the newly launched surgical training center. A pre-course seminar on lower extremity osteotomies was organized which was attended by Finnish orthopaedic surgeons. The presentations were impressive and it was a delight to hear the experience of senior surgeons, who later confessed how nervous they were as they had to repeatedly rehearse their presentations in English – just for us. That afternoon, we scrubbed with Dr Sillanpaa on 2 surgical cases, an ACL reconstruction in a skeletally immature patient and MPFL reconstruction for patellar instability. The evening was relaxing with the unique experience of Finnish tradition at Sauna Hangaslahti, followed by dinner prepared by local chefs. On Oct 10, there was an academic conference on patellofemoral joint at the Tampere University Hospital. We both gave two presentations related to patellofemoral instability and there were thoughtful exchanges of ideas during the conference. The afternoon surgical cases included a trocheloplasty with MPFL reconstruction and an MPFL reconstruction using adductor longus autograft in a skeletally immature patient. The evening dinner was at Finlayson Palatsi restaurant in the heart of Tampere. 

London, UK (Oct 13, 2014) 


We met Professor Andrew Amis at the Imperial College in London on Monday morning; it was raining, as expected. Founded in 1907, Imperial College London is one of the world’s best science-based institutions. Professor Amis gave us a guided tour of his biomechanical lab, including the history, development and basis for several workstations in the lab. He introduced us to a robot in his lab that has been used to study joint biomechanics. The display of heavy-duty automatic gun on his shelf could give an insight towards his love for machines. We met Joanna Stephen, MSc in the lab who gave us an in- depth review of all the patellofemoral cadaveric experiments that she had been involved with. At noon, we presented our perspective on patellofemoral joint at the weekly research meeting and enjoyed interacting with postdoctoral and PhD research fellows and students. This was followed by lunch in the cafeteria of Victoria and Albert museum, the world’s largest museum of decorative arts and design. We had nice discussions about potential biomechanical research related to PF joint. That evening we headed to Norwich. 

Norwich, UK (Oct 14 – Oct 15) 


Just 2 hours north of London, Norwich has a wealth of historical architecture and medieval churches. Professor Simon Donell welcomed us in his countryside house and introduced us to his family members which included 4 cats, 3 Alpacas, a few chickens and a horse. The fabulous meals at his house were prepared using home-grown eggs, vegetables and fruit. The morning of Oct 14th was spent at Norfolk and Norwich Hospital where Professor Donell showed us a video presentation of his modified trochleoplasty and a sample of complex cases that were treated by him in past. The afternoon was spent in the new patient clinic, where we had a chance to examine several referred patients with complex patellofemoral disorders, including patients with failed previous patellar stabilization procedures and a subluxed patellofemoral joint with arthrosis. The dinner was hosted by Professor Donell at ‘The Wildebeest’ – an African themed restaurant with great food. The morning of Oct 15th was spent in the operating room for a complex case of habitual / obligatory dislocation of patella in flexion. The surgery 

comprised of distal femur de-rotational osteotomy, Albee trochleoplasty, MPFL reconstruction and quadricepsplasty. After surgery and rounding on inpatients, we headed to the airport on our way to Munich. 

Ulm and Oberstdorf, Germany (Oct 16-Oct 17) 


On Oct 16th, we arrived in Ulm which was an hour long train-ride from Munich. Ulm is a city in southern Germany and is the birthplace of Albert Einstein. We were greeted by Dr. Sabine Lippacher, who accompanied us to the Institute of Orthopaedic Research and Biomechanics at University of Ulm. She introduced us to the head of the Joint Biomechanics Group, Professor Dr. Lutz Durselen, who gave us the tour of the lab; the lab was unique and immaculate. It was an all-in-one research center including capabilities for studies related to biomechanical engineering, cell biology, histopathology, microCT and computer modeling. Dr. Lippacher explained to us her experiments that were conducted in the lab to detect PF contact forces after MPFL reconstruction. 


That evening, we reached Oberstdorf, a hiking and skiing town in southwest Germany, located in the Bavarian Alps. Dr. Manfred Nelitz received us at the train station. At dinner, he talked about his training in pediatric orthopaedics and how it has helped him to understand the developmental issues related to patellofemoral joint. On the morning of Oct 17, he picked us up from the hotel and we headed to the operating room. We assisted him in an MPFL reconstruction using a sleek technique of quadriceps tendon graft harvest. We continued case based discussions related to trochleoplasty, arthroscopic assessment of trochlear dysplasia, patellofemoral instability in skeletally immature patients and role of de-rotational osteotomy in management of patellofemoral disorders. 

Oct 18: After two weeks of learning, sharing and fun, we said au revoir, nähdään, see you later and Auf Wiedersehen to each other