1.3.1 - Generational Gap - A Senior Surgeon Perspective
no introduction required
Let me share some philosophy and thoughts as a senior surgeon.
Since humans are on this planet teaching was done by the master to the student.
And when techniques were involved, the teaching was also live
Communication was person to person. No alternatives here.
In orthopaedics as in all of surgery learning from the master was the way to go.
“I told you so or I showed you so” was the slogan.
That is how I was trained long ago and appreciated it all the way.
Orthopaedics and trauma treatment are based on a good diagnosis.
The clinical diagnosis that is. Back then no more was around.
History taking was basic and you needed the tricks to get it all out of the patient.
Though I still stick to these principles I see a change in practice towards more technical information more imaging information
Missing what my teachers told me
Masses of information now is made available from new techniques and imaging sources
sometimes with frightening details that scare patient and families
However, missing out on therapeutical impact
And then again
I lived through the origin of arthroscopy and I am staying alive through its technical improvements today
Nevertheless, the abuses on the matter
Too many menisci were removed during last century and this has come around more recently to the benefit for all
But then again too few ACL s were treated at the same time to save the knee
We now know they work together to stabilize the injured knee and prevent degeneration
In the while hypes came up and disappeared again as indeed they are hypes
The likes of double bundle vs single bundle, the existence or not of the ALL, the value of zero alignment or just keep it as it is. And more to come
Good decisions come from experience and good experience comes from bad decisions
The same is true for the diagnosis and the treatment that follows
As experience comes with time and age, share your master s experience and let it reach your students over time
The benefits will be huge to the individual patient but also to the community as this is all we strive for
In Orthopaedics clinical experience is the heart of the matter, imaging may shed some more light on the problem leading to a correct treatment and a satisfied patient pursuing his individual and intimate goals
XXXXX XXXX XXXX XXXXX XXXXX XXX XXXXXX XXX XXXX XXXXX XXX XXXXXX XXXX XXXXX XXXX XXXXX XXXXX XXXX XXXX XXXXX XX XXXXXX XXXX XXXX XXX XX XXX XX XX XXXX X XXXXXX X XX XXX XXX XXX XXX XXXX XX XXX XXX XX XXX XXXXXX XXXX XXXX XX XXX XX XXXX XXX XXXXXXXXXXX XXXXXXXXXXXX XXXXXXXXXXXX XXXX XXXX XXXX XXX XXXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX
to my teachers
to my father who told me to leave this place a better place than when i found it ....................
1.3.3 - Surgeon vs Scientist Gap - The Surgeon Perspective
1.3.4 - Surgeon vs Scientist Gap - The Scientist Perspective
This presentation will focus on my scientist perspective during my post-doctoral research at the University Medical Center Utrecht, The Netherlands.
Part of my highlights consisted of providing academic “meet-the-patient” lectures and making other informative communications with patients1. These patients participated in an academic driven phase I / II clinical trial that investigated the safety and efficacy of a one-step combination of allogeneic mesenchymal stromal cells (MSCs) and autologous chondrons to treat cartilage defects (IMPACT - NCT02037204)2-4. A multidisciplinary team consisting of basic scientists, orthopaedic surgeon and researchers with experience in developing and manufacturing advanced therapy medicinal products (ATMPs) took this research from scratch through non- and pre-clinical research to clinical trials5-7.
In such a multidisciplinary team members speak a different language, have different needs and views and here it is very important to understand each other and to get everyone on the same page. In addition, as a basic scientist, coming from a background in molecular biology, you find yourself in a whole new kind of research area (translational and clinical research). I went from cloning genes to patient reported outcome scores and cost-effectiveness studies. One must want to put in the effort to get to know this new field and also be able to identify opportunities to improve the quality and findings of the research. I enjoyed every part of this challenging and succesful journey and learned so much; not only on doing other types of research but also others skills with a supervisor and other team members with a completely different background.
2 de Windt TS, Vonk LA, Slaper-Cortenbach ICM, Nizak R, van Rijen MHP, Saris DBF. Allogeneic MSCs and Recycled Autologous Chondrons Mixed in a One-Stage Cartilage Cell Transplantion: A First-in-Man Trial in 35 Patients. Stem Cells. 2017 Aug 1;35(8):1984–93.
3 de Windt TS, Vonk LA, Slaper-Cortenbach ICM, van den Broek MPH, Nizak R, van Rijen MHPP, et al. Allogeneic Mesenchymal Stem Cells Stimulate Cartilage Regeneration and Are Safe for Single-Stage Cartilage Repair in Humans upon Mixture with Recycled Autologous Chondrons. Stem Cells. 2017 Jan 1;35(1):256–64.
4 Saris TFF, de Windt TS, Kester EC, Vonk LA, Custers RJH, Saris DBF. Five-Year Outcome of 1-Stage Cell-Based Cartilage Repair Using Recycled Autologous Chondrons and Allogenic Mesenchymal Stromal Cells: A First-in-Human Clinical Trial. Am J Sports Med. 2021;49(4):941–7.
5 Vonk LA, de Windt TS, Kragten AHM, Beekhuizen M, Mastbergen SC, Dhert WJA, et al. Enhanced cell-induced articular cartilage regeneration by chondrons; the influence of joint damage and harvest site. Osteoarthr Cartil. 2014 Nov 1;22(11):1910–7.
6 De Windt TS, Saris DBF, Slaper-Cortenbach ICM, Van Rijen MHP, Gawlitta D, Creemers LB, et al. Direct Cell–Cell Contact with Chondrocytes Is a Key Mechanism in Multipotent Mesenchymal Stromal Cell-Mediated Chondrogenesis. Tissue Eng Part A. 2015 Oct 1;21(19–20):2536–47.
7 Bekkers JEJ, Tsuchida AI, Van Rijen MHP, Vonk LA, Dhert WJA, Creemers LB, et al. Single-stage cell-based cartilage regeneration using a combination of chondrons and mesenchymal stromal cells: Comparison with microfracture. Am J Sports Med. 2013 Sep;41(9):2158–66.
As clearly mentioned in the content, this research was part of a multidisciplinary team and as part of that I would line to acknowledge Daniel Saris, Tommy de Windt, Ineke Slaper-Cortenbach, Jasmijn Korpershoek and Roel Custers