IOC Sports Medicine Course for doctors with a love for sports

IOC Sports Medicine Course for doctors with a love for sports

In early May, 23 doctors from 17 countries visited Amsterdam to sit the exam for the IOC Sports Medicine Course. They had studied online and learned about the principles of sports medicine for two years. Now it was time for three days of live learning about daily sports medical practice in the Amsterdam UMC, where the final exam was taken.

The course was founded in 2015, at the initiative of the International Olympic Committee (IOC). The reason was the difference in expertise that the medical committee of the IOC noted among the doctors at the Olympic Games. A consequence of the fact that not everyone has good access to sports medicine education and training. To improve this, the 11 IOC-accredited research centers in the world, including Amsterdam UMC, were asked to provide e-learnings for an online sports medicine course.

Reflection of daily practice
After completing the online course, students can take the exam in Amsterdam, Oslo, Pretoria or Seoul. The research centers in these cities make their own course content in the buildup to the exam. The idea is to have three more days of education before the exam takes place. In Amsterdam UMC, the specific emphasis is on medical care for athletes. The course participants become acquainted with sports medicine and the adjacent specialties of sports orthopedics, sports radiology and sports cardiology. In addition, medical care after a concussion and mental health and illness are discussed. Sports doctor Hans Tol: “This is a reflection of our daily practice and of where our research focusses on. The great thing is that through this course we can share all our knowledge with everyone in the world.”

Interactive
The feedback from the students was very positive. But those who taught  the course for three days were also brimming with energy at the end. Orthopedic surgeon Gino Kerkhoffs: “The education was very interactive. Discussions took place between, and with the doctors based on real case studies. Very different topics, which are also relevant in elite sports, were highlighted. This ranged from child psychiatry and cardiology to working together in a team with radiology, orthopedics and sports medicine and coaching at the Olympic Games in a team around the athlete. You realize once again how well we have organized sports medical care here in the Netherlands and in Amsterdam UMC. And that that is very educational for other people.”

Advanced course
Over the years, 511 doctors from 77 countries have successfully completed the basic course. For those looking for further depth, there is also an advanced course. This takes place every year in a different part of the world. Hans Tol: “We will see some of the doctors who have now obtained their IOC diploma in Colombia in the autumn.”


Study from Amsterdam featured in BSCOS PODcast

Study from Amsterdam featured in BSCOS PODcast

A recent study from the Amsterdam Team has been featured in episode 4 of the Paediatric Orthopaedic Digest podcast from the The British Society for Children’s Orthopaedic Surgery.

The respective study is a systematic review about tarsal coalitions and reports the success rate after different treatment options. The study concludes that 8 out of 10 patients do well after surgery.

We are honored that a study from our center has been discussed and is, by the authors of the podcast, classified as ‘most impactful studies that we feel can change practice or improve outcomes in Paediatric Orthopaedics’.


Amsterdam Ankle Cartilage Team Accredited Official ICRS Center of Excellence

Amsterdam Ankle Cartilage Team Accredited Official ICRS Center of Excellence

The Amsterdam Ankle Cartilage Team is proud to announce – on behalf of and as part of the Orthopaedic Surgery Department and the Academic Center for Evidence-bases Sports medicine (ACES) – that it has been accepted as an ICRS (International Cartilage Regeneration & Joint Preservation Society) Center of Excellence. The application to become a center of excellence has been rewarded with the official entitlement of a Center of Excellence.

As the ICRS writes on their website, an ICRS teaching Center is described as “the recommended place-to-go to for unique one-on-one learning experiences and practical advice from world leading experts on current state-of-the-art cartilage repair surgical techniques, patient evaluation and non-operative treatment of cartilage injury”. The ICRS states that these centers are serving as outstanding professional development experiences for fellows, residents & students (ICRS members).

The Amsterdam Ankle Cartilage Team went through a selective and though selection process in which the clinical excellence, educational commitment, scientific activities as well as involvement in the ICRS was tested for qualification. Concerning the department and the collaborating teams, one can note that the Amsterdam Ankle Cartilage team is embedded within and beyond the department of orthopaedic surgery of the Amsterdam UMC, which is an orthopaedic sports medicine clinical and research institute on its turn embedded in both the Academic Center for Evidence-based Sports medicine (ACES). The program on treatment of cartilage damage has officially been accredited as an Expert Centre for the treatment of foot and ankle cartilage injuries in 2018 by the Netherlands Federation of University Medical Centers (NFU and focuses on both the clinical and research part of the injured patient with a cartilage lesion.

Over the past decade, multiple novel surgical interventions have been developed and proven effective in our treatment algorithm for cartilage and osteochondral lesions of the lower extremity. Furthermore, our treatment algorithm is supplemented with an inventive minimally invasive arthroscopic technique – the Nanoscope™ which is a novel system that is used for instant diagnostic imaging and less invasive arthroscopic procedures. This technique is accompanied by a strong research line. The clinical care for patients with a cartilage lesion goes hand in hand with research guided by increasing insights in diagnosis and (minimally invasive) treatment from the latest scientific research. Our current team is active and consists of (associate) professors, post-doctoral researchers, PhD-candidates, and motivated and active students conducting scientific research. The active nature of our team has led to the production of numerous cartilage-related publications over the past decade.

Currently, there is a diversity of research projects that have been initiated and are ongoing. We look at cartilage damage as pillars which we research as incremental cartilage damage in the ankle: the cascade analogy. Hence, we research the (primary and secondary) prevention, diagnosis and (after-)treatment of very early cartilage damage, osteochondral lesions and end-stage osteo-arthritis. Furthermore, new surgical techniques have been developed that are now standard care, such as Fixation Procedures of fragmentous osteochondral lesions and Autograft Procedures including osteoperiostic grafts from the iliac crests. Additionally, we continuously research innovative (preventive) interventions. Besides this, we are currently performing Randomized Controlled Trials (RCTs) for cartilage lesions of the ankle. Visitors are more than welcome to become a member of our diverse research team and provide innovative novel ideas.

As a conclusive remark, we can say that we are extremely happy to be an official ICRS scientific and clinical Center of Excellence, and our role as a Center of Excellence to aim to contribute to the ICRS community by helping their members improve both their clinical and scientific skill in our internationally recognized learning environment will be taken highly seriously.


Efficacy of Platelet-rich Plasma Injections for the Treatment of Ankle Osteoarthritis

Efficacy of Platelet-rich Plasma Injections for the Treatment of Ankle Osteoarthritis

Recently a placebo-controlled, double blind, multicenter, randomized trial concerning the efficacy of intra-articular Platelet-rich Plasma (PRP) injections for the treatment of ankle osteoarthritis was published in the JAMA. The findings were covered by “the Health Report” a broadcast on the Radio National network of the Australian Broadcasting Corporation, Australia’s national public broadcaster.

Listen 5m26

Winner 'Diamond D’Honneur'

Winner ‘Diamond D’Honneur’

Former short track skater Margriet de Schutter won the prestigious ‘Diamond d’Honneur’ during the largest international sports film festival in Milan this week. She got this because of her book ‘The Secret Balance of Champions‘, in which she recorded more than 30 stories from top athletes. She also competed at the highest level, until physical setbacks got in the way of her goal – the Olympics.

See the whole interview

JAMA Publication for ACES team

JAMA Publication for ACES team

An injection into the ankle joint with Platelet Rich Plasma (PRP) does not work better in ankle osteoarthritis than an injection with saline. This is the main conclusion from a multicenter RCT, initiated and coordinated at the Amsterdam UMC. The results were published Oct. 26th 2021 in the Journal of the American Medical Association (JAMA).

Injecting PRP has been a popular therapy for joint, muscle and tendon disorders. The idea is that injecting your own blood plasma with a high concentration of platelets has a beneficial effect on the healing process, because growth factors are released from the platelets.

Hesitant

Sports physician and lead researcher Hans Tol, who conducted the PRP study together with researchers from Bergman Clinics, Erasmus MC, Flevoziekenhuis, OLVG and Spaarne Gasthuis, says that they were initially reluctant to start a study into the use of PRP in ankle osteoarthritis. “Eleven years ago, we were the first to investigate the effect of PRP in Achilles tendon injury in a RCT. We found no effect at the time and those results were also published in the JAMA. But due to clinical experience and in particular the recurring question from patients with ankle osteoarthritis, we started to have doubts. And when other research showed that PRP injections lead to less pain and disability patients with knee osteoarthritis, we decided to conduct this. Financial support from ReumaNederland made this possible.”

Advanced osteoarthritis

In osteoarthritis, the layer of cartilage in the joint has become thin and irregular. This causes pain and prevents the joint from moving smoothly. In contrast to knee and hip osteoarthritis, ankle osteoarthritis is more common at a younger age. This is because in 70-80% of cases it secondary to trauma, such as a broken bone or frequent ankle sprains. “The initial trauma causes very local damage to the cartilage,” explains co-researcher and head of Orthopedics Gino Kerkhoffs. “We can treat this well surgically, which in many cases prevents progression to osteoarthritis. In advanced osteoarthritis, the cartilage in the entire joint is affected and we can fixate the ankle joint or place an ankle prosthesis. These are major operations that we do not prefer at a young age.” “However, there is not yet a good non-operative therapy in advanced osteoarthritis, continues orthopedics physician-researcher Liam Paget, who coordinated the research in all hospitals. “Only interventions, such as strengthening the muscles around the affected joint – in this case foot and calf muscles – and losing weight are of added value. That is why we did this research on a non-surgical altenative.”

No difference

100 adult patients with ankle osteoarthritis were included in the six centers for the study. They were required to have a mean pain score of at least 40 on a scale of 100 and X-ray evidence of ankle osteoarthritis. Blood was taken and PRP prepared in all patients. On the basis of lottery, half of them received a PRP injection, the other a saline solution injection (placebo). After six weeks, the injection was repeated. In addition, the patients completed questionnaires at baseline and after 6, 12 and 26 weeks. Physical examinations were also performed three times during this period.

The results showed that there was no difference between the two groups. Tol: “Because we included patients from academic, peripheral, top clinical and independent centers, the results of our study can be generalized well.”

Do not administer anymore

“Of course we had hoped that the PRP injections would offer a solution for people with ankle osteoarthritis, but unfortunately we have to conclude the opposite,” says Paget. “Our advice to practitioners is to stop administering PRP injections in these patients. They don’t work. Moreover, it is an expensive therapy that belongs to the non-insured care. Patients therefore have to pay for it out of their own pocket.”

Future research

For Kerkhoffs, the study results are reason to focus future research on other biological injectables and an injectable gel cushion. “We are a center of expertise of the Dutch Federation of University Medical Centers (NFU) in the field of cartilage and underlying bone defects of the ankle. It is our mission to have an appropriate treatment for all phases of cartilage damage. In the upcoming studies, we will focus on the phase just after a trauma with the aim of repairing the initial, local cartilage trauma and ultimately preventing progression to ankle osteoarthritis. In this way we hope to eventually solve the problem.”


ON Pilot Grant Talus 2021

ON Pilot Grant Talus 2021

Congratulations to the Amsterdam Ankle Cartilage Team.

The team applied for the ON Pilot Grant Talus 2021. It is our big pleasure to inform everyone that the research proposal with the title “Osteochondral lesions under 15mm of the Talus; is iliac crest Bone marrow Aspirate Concentrate the Key to success? The OUTBACK Trial” has been awarded a research grant of 25.000 CHF; the financial support will be used to conduct the multicenter RCT over the coming period.


Vincent Gouttebarge

Vincent Gouttebarge

Appointment as Extraordinary Professor (Section Sports Medicine) at the University of Pretoria (South Africa) per 1 March 2021.

Involvement in the academic programme of the Section Sports Medicine, which include research collaboration and student supervision.

Professorship will enable the collaboration of Professor Kerkhoffs and I with Professor Christa Janse van Rensburg, the Head of Section Sports Medicine at the University of Pretoria. Our collaboration will focus on the health of professional football and rugby players. We intend to start this year with 3 PhD projects and we will recruit 3 PhD candidates in the upcoming months.


Five years Amsterdam collaboration on health and safety in sports

Five years Amsterdam collaboration on health and safety in sports

In 2016 is Amsterdam Collaboration on Health and Safety in Sports (ACHSS) geaccrediteerd als een van de elf wereldwijde IOC-research centra. Nu, vijf jaar later, blikt het ACHSS team terug en kijkt het vooruit. Wat heeft de samenwerking in Amsterdam opgeleverd?


Ankle Cartilage Team: Jari Dahmen

Amsterdam Ankle Cartilage Team: Jari Dahmen Appointed Editor KSSTA Journal and Editorial Board Member CARTILAGE Journal

Care for athletes goes hand in hand with high-quality research. At ACES, patient care is guided by ever increasing insights in diagnosis and treatment from the latest scientific research. The department of Orthopaedic Surgery of Amsterdam UMC has been officially accredited as an Expert Centre for the treatment of ankle cartilage injuries in 2018. The foundation of its clinical research is rooted in a wide network of an enthusiastic research and clinical team. Jari Dahmen currently helps to coordinate this team of researchers in the field of ankle cartilage, which led to the publication of numerous high-quality scientific reports. The continuous efforts for the best evidence are in the service of patients and their families being impacted by cartilage damage in the ankle.

The contributions of Jari to the field of ankle cartilage repair has not gone unnoticed. At the end of 2020 Jari was appointed as (web-)editor at the KSSTA journal from the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) and as Editorial Board member for the CARTILAGE Journal – which is the official journal of the International Cartilage Regeneration & Joint Preservation Society (ICRS). He is furthermore involved as a Board Member in the International Society for Cartilage Repair in the Ankle (ISCRA).

Jari emphasizes that these accomplishments are predominantly thanks to the concerted group efforts of the enthusiastic young (student) researchers, research fellows, and doctors that are all part of the Amsterdam Ankle Cartilage Team and happily works together within this team.