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The 2019 Arthroscopy Association of North America Traveling Fellowship—Los Gallos: New Friends on an Old Town Road
AANA Traveling Fellowship Report
The 2019 Arthroscopy Association of North America Traveling FellowshipdLos Gallos: New Friends on an Old Town Road Fernando Hernández-Pérez, M.D., Michael H. Amini, M.D., Andrew J. Sheean, M.D., Aravind Athiviraham, M.D., and John C. Richmond, M.D.
Abstract: We came in with high expectations, yet the Arthroscopy Association of North America (AANA) Traveling Fellowship far exceeded them. The 4 traveling fellows came from different backgrounds, different parts of North America, and different practice settings, including an independent private practice, a hybrid private-academic practice, the military, and academia. We were lucky to have been ushered along the way by our godfather, the distinguished John Richmond, M.D., Past-President of AANA and Associate Editor Emeritus of Arthroscopy, who was gracious enough to give his time to the expedition. Over the course of the journey, this gang came together quickly and forged relationships that will last a lifetime. We are extremely grateful to AANA for the privilege and will cherish the memories for years to come.
W
e are so honored to have been selected as the 14th class of the Arthroscopy Association of North America (AANA) Traveling Fellowship. As many have described before, it was a once-in-a-lifetime experience. During the 2-week period, we had a unique combined experience of brotherhood and academia. This year’s fellows included Aravind Athiviraham, M.D., from the University of Chicago; Michael H. Amini, M.D., from The CORE Institute in Phoenix; Fernando Hernández-Pérez, M.D., from Alta Especialidad en Ortopedia in San Luis Potosi, Mexico; and Andrew J. Sheean, M.D., from the San Antonio Military Medical Center. It was such an honor to share this experience with John C. Richmond, M.D., Past-President of AANA and Associate Editor Emeritus of Arthroscopy, from New
From Alta Especialidad en Ortopedia (F.H-P.), San Luis Potosi, Mexico; The CORE Institute (M.H.A.), Phoenix, Arizona, U.S.A.; San Antonio Military Medical Center (A.J.S.), San Antonio, Texas, U.S.A.; University of Chicago (A.A.), Chicago, Illinois, U.S.A.; and New England Baptist Hospital (J.C.R.), Boston, Massachusetts, U.S.A. The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Received July 10, 2019; accepted July 15, 2019. Address correspondence to Michael H. Amini, M.D., The CORE Institute, 1500 S Dobson Rd, Ste 202, Mesa, AZ 85202, U.S.A. E-mail: Amini. [email protected] Ó 2019 by the Arthroscopy Association of North America 0749-8063/19874/$36.00 https://doi.org/10.1016/j.arthro.2019.07.012
England Baptist Hospital in Boston, serving as godfather. However, it was tough to keep up with his level of activity. He was the first one ready to go every morning and the last one ready to call it a night every evening.
Mississippi Sports Medicine and Orthopaedic Center Our first stage of the journey started on an Easter egg “hunt” on Easter Sunday from our hometowns all the way to Jackson, Mississippi, where Dr. Larry Field, current President of AANA, served as our host. The Mississippi Sports Medicine and Orthopaedic Center (MSMOC) team made arrangements for us to stay at the Fairview Inn, an incredible, recently renovated 1908 mansion. The members of the traveling fellowship had a staggered arrival into Jackson, with some arriving in time to enjoy Easter brunch at 1908 Provisions inside the Fairview Inn with Dr. Field and his wife Dr. Cindy Field. We had a great dinner with the Drs. Field, along with some of the other faculty and fellows from the MSMOC at Char Steakhouse, where we started our southern-diet culinary exploration. Our gracious hosts in Jackson ensured we stayed not only well fed but stuffed during our entire stay. Back at the hotel, we had the opportunity to get to know each other, enjoying a sip of red wine kindly provided by our hosts. On our first day, we witnessed a master class of combined efficiency and a minimalistic approach to deal with 2 massive rotator cuff repairs using Dr. Field’s described double-row rip-stop technique,1 2 instability
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cases with a Bankart repair and remplissage, and an arthroscopic tennis elbow surgical procedure, all of them finished by lunch with time to spare (Fig 1A). As usual, mealtime was spotlighted on our agenda. We went to a local staple, Keifer’s, for some gyros and a lively discussion on different topics like the use of the Latarjet procedure and the Bankart remplissage.
We returned to surgery, where Dr. Walter Shelton, another AANA Past-President, performed several interesting cases, including posterior medial condyle cartilage repair with microfracture through a posteromedial portal, 2 partial meniscectomies, and a very rare case of medial snapping knee due to an aberrant semimembranosus distal insertion. During these cases,
Fig 1. (A) Mississippi Sports Medicine and Orthopaedic Center, home to multiple presidents of the Arthroscopy Association of North America (AANA), with Current AANA President, Larry Field, M.D. From left: Fernando Hernández-Pérez, Past-President and Godfather John Richmond, Current President and site-host Larry Field, Aravind Athiviraham, Andy Sheean, and Michael Amini. (B) Photograph with PastPresident Walter Shelton, M.D. From left: Michael Amini, John Richmond, Walter Shelton, Andy Sheean, Aravind Athiviraham, and Fernando Hernández-Pérez.
AANA TRAVELING FELLOWSHIP
we had the opportunity to discuss Dr. Shelton’s 15 years of experience using quadriceps tendon autograft and catch some tips on transmeniscal portals, piecrusting the medial collateral ligament for tight medial compartments, and the safety and utility of popliteal tendon stitches when repairing a lateral meniscus (Fig 1B). In the afternoon, we came back to the MSMOC and experienced a great wet laboratory guided by Dr. Austin Barrett, exploring and reconstructing lateral and posterolateral corner structures using the LaPrade technique,2 followed by a posterior knee structure dissection, examining the posterior cruciate ligament, meniscal root attachments, and neurovascular bundle, as well as a review of different techniques of lateral extra-articular tenodesis. After finishing with the knee, we performed a Latarjet procedure, learning important tips from Dr. E. Rhett Hobgood about exposure and graft fixation, as well as a simple yet effective way to mount the specimen in a more anatomic position. We went back to the Fairview Inn to get dressed for another wonderful meal, at Koestler Prime, and a tremendous talk from our godfather entitled “The Journal of Retractions,” where he offered an incredibly candid appraisal of many of his contributions to the orthopaedic literature ranging from early experiences with thermal capsular shrinkage to the first description of a suture anchorebased Bankart repair. The next morning, we observed 3 great cases with Dr. Jason Craft, including 2 hip arthroscopies with labral repair and femoral neck osteoplasty, as well as a quadriceps tendon anterior cruciate ligament (ACL) reconstruction. He made it look so much easier than we were used to that he may have sparked the interest of
Fig 2. Learning about authentic mezcal. From left: Andy Sheean, John Richmond, Fernando Hernández-Pérez, Aravind Athiviraham, and Michael Amini.
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some of us, perhaps, in jumping into the hip arthroscopy world. We headed back to the MSMOC for lunch and our first academic program, which included lectures by the hosts and the guests that sparked lively debates about the current state of the art in controversial topics. We were also privileged to listen to another talk from our godfather, “Leadership by Example,” something all in the audience were eager to hear from such an accomplished teacher, mentor, and gentleman. That evening, Dr. Field hosted us at his beautiful lake house, where we had an amazing dinner and a night filled with friendship and camaraderie. The godfather gave our host, Dr. Field, and the fellows quarter-zip jackets, and the MSMOC staff were so generous in presenting each of us with a painting of the Mississippi River by Wyatt Waters, a renowned Mississippian artist. Dr. Hernández-Pérez then introduced the group to mezcal from his hometown, the first of many exposures during the trip (Fig 2). The next day, we had another filling breakfast and a morning conference on posterior cruciate ligament reconstruction from Dr. Craft before heading to the airport and making our way to Winston-Salem!
Wake Forest University We arrived at the Greensboro airport and settled into the Kimpton Cardinal Hotel in Winston-Salem, an awesome, historic building from 1929, once headquarters to R. J. Reynolds Tobacco Company and eventual architectural inspiration for the Empire State Building. That night, we met our host, Dr. Brian Waterman, a previous AANA traveling fellow, and had dinner at the Katharine Brasserie & Bar on the patio with the entire Wake Forest Department.
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Our next day started with coffee with Dr. Andrew Koman, Chairman of Orthopaedics, and Dr. Kevin High, President of Wake Forest Baptist Health. We split into 2 groups. Drs. Richmond and Hernández-Pérez went to watch Dr. John Hubbard perform an arthroscopic gluteus medius repair, an autologous hamstring ACL reconstruction, and a meniscectomy. Drs. Athiviraham, Amini, and Sheean spent the morning with Dr. Waterman. He performed a medial patellofemoral ligament reconstruction with an osteochondral fracture repair, an arthroscopic Bankart repair, a posterior capsulorrhaphy and subpectoral tenodesis, and a meniscectomy. We had lunch and then went to the David F. Couch Ballpark, where we had the opportunity to admire and even try its state-of-the-art motion analysis laboratory to break down pitching mechanics and understand how injuries happen. Here, we realized the limit of our pitching skills. Fortunately, there were no injured labra or rotator cuffs, just injured pride. We then had a glance at the future of medicine when visiting and admiring the work of Dr. Anthony Atala at the Wake Forest Institute for Regenerative Medicine. Remember the ear grown on the back of a rat? That was Tony Atala’s tip of the iceberg. The institute is 3dimensionally bioprinting organs in the laboratory from scratch. This visit opened our eyes to near-future applications of this technology in our field, such as 3dimensionally printed, cell-seeded scaffolds for reconstructing bone defects, musculotendinous units, and osteochondral plugs. That evening, we were hosted at the Forsyth Country Club by Dr. Gary Poehling, Chairman Emeritus at Wake Forest and Editor-in-Chief Emeritus of Arthroscopy, as well as the rest of the Orthopaedic Department. We enjoyed another evening of relaxation, fellowship, and a light academic program. The next morning, we watched Drs. Ben Graves, Kevin Coates, and Brian Waterman perform a multitude of arthroscopic cases, including several rotator cuff repairs, ACL reconstructions, and shoulder stabilizations. After surgery, we visited the Wake Forest training room and workout facilities, an all-inclusive facility with stateof-the-art technology, including blood flow restriction, isokinetic training, and low-gravity treadmills. In the afternoon, we met the Sports Medicine Department at Foothills Brewery and enjoyed a couple of samples of one of their local staples. We then spent the evening in the Wake Health Box at the Dash Minor League Baseball game. Dr. Waterman, who serves as team physician, took us through the locker room and training room, where we had a chance to meet the head athletic trainer and were presented with our very own Dash “swag” (game-ready, fitted hats!). On Saturday morning, we set out for Hanging Rock State Park for several hours of hiking and enjoying
lunch at a beautiful landmark including rocks and waterfalls. We then came back to the hotel for what seemed to be one of our few unscheduled blocks of time. We made our way to the hotel’s recreation center, where we found a half-court basketball court and decided to risk our ACLs and Achilles tendons in a twoon-two game where Dr. Athiviraham started his winning streak as team Athiviraham-Amini beat team SheeaneHernández-Pérez despite Dr. Sheean’s incredible efforts and athleticism. Grateful there were no injuries, we got ready for a special afternoon at the home of Dr. Poehling (Fig 3). We learned all about mallets and wickets and got ready to continue competition in a very fun croquet tournament on his regulation court. It was again Dr. Athiviraham, this time along with Dr. Hubbard, who took the top prize. Dr. Poehling then hosted us for dinner in his historic greenhouse that was rescued from demolition, moved to his property, and fully restored into a truly beautiful space. There, we enjoyed a delicious menu prepared on-site by chef Charles Paynter from Five Loaves Catering that was paired perfectly with a taste of North Carolina’s famous Raffaldini Vineyard. After dinner, we found our way to the Old Winston Social Club, where we continued the competitive spirit of the day on the shuffleboard tables, along with a table-sized pizza and a couple of beverages. This capped off quite a time in Winston-Salem.
Fig 3. Dr. Gary Poehling’s croquet court. The trip to Wake Forest was capped off with an evening croquet tournament followed by dinner inside the greenhouse (background) at Dr. Poehling’s house. From left: Andy Sheean, Aravind Athiviraham, Gary Poehling, John Richmond, Michael Amini, Fernando Hernández-Pérez, and site-host and prior traveling fellow Brian Waterman.
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University of Florida The next morning, we flew from Winston-Salem to Orlando, rented a car that could have fit 2 groups of traveling fellows, and drove to Gainesville, where we enjoyed a low-key dinner at Shula’s Steakhouse. The following morning, we were warmly greeted by our host, Dr. Kevin Farmer, yet another previous AANA traveling fellow. We had the opportunity to watch Dr. Farmer skillfully perform 2 ACL reconstructions (1 with boneepatellar tendonebone autograft and 1 with hamstring autograft) augmented with a FiberTape (Arthrex) as an InternalBrace (Arthrex).3 This was followed by an interesting rotator cuff repair in the lateral position. In the evening, we had the opportunity to listen to internationally renowned trauma surgeon Dr. Michael McKee, who was a visiting professor that day, give an insightful grand rounds presentation entitled “Clavicle Fractures: How Science Changed Practice.” For dinner, we were treated to delicious sushi at Dragonfly Sushi in downtown Gainesville, where we had the chance to taste some of the most delicious and original sushi creations, including butter-fried rib eye. We were fortunate to be joined by one of the great leaders of sports medicine, Dr. Pete Indelicato. We enjoyed listening to his interesting anecdotes from his storied career as head team doctor for the Florida Gators. The following morning, we had the opportunity to watch Dr. Bradley Schoch perform an impressive arthroscopically assisted lower trapezius tendon transfer4 for a massive irreparable rotator cuff tear. Following lunch, we had the opportunity to visit the “The Swamp” (i.e., Ben Hill Griffin Stadium) and the University of Florida Gators football team facilities. Looking at all the plaques highlighting the number of former Gators who went on to become NFL greats was truly awe-inspiring. The memorable stadium tour was followed by our academic program, where we had the opportunity to give our final presentations of the traveling fellowship. Undoubtedly, the highlight of our time at the University of Florida was the following day when we had the incredible and thrilling experience of riding on an airboat in the open marshlands along the Suwannee River (Fig 4). Dr. Hernández-Pérez was literally “blown away” by the powerful fan of the airboat. We also had the chance to enjoy choice beverages while listening to an engaging R&B/hip-hop music collection with the spectacular acoustics of the airboat. We all still fondly think of this moment every time “Old Town Road” plays on the radio.
Orlando and AANA 2019 Annual Meeting After that unique experience, we set out on the back roads of central Florida headed for Orlando, stopping at
Fig 4. Air boating in the Florida swamp. From left: site-host and prior traveling fellow Kevin Farmer, Aravind Athiviraham, Andy Sheean, Fernando Hernández-Pérez, and Michael Amini.
a truly unique spot for a taste of the local fare (Burger King), and arrived just in time to attend the President’s Reception, which took place in the center of the hotel in its island-themed grotto meeting space. We were honored to meet many of the AANA leadership and reconnect with Drs. Field, Waterman, and Poehling. It was exciting to finally meet Dr. Denver Stanfield, the chairman of the traveling fellowship committee, and share our amazing experiences on this traveling fellowship with him. We met many of the previous AANA traveling fellows, and it was inspiring to see how fondly they all still recall their own traveling fellowships, as well as the relationships that they forged along the way. The following day, we had the chance to attend an excellent scientific program, including captivating live operations and informative instructional course lectures. We were so honored to participate in Fellows’ Day, where the afternoon was kicked off by an inspirational speech by Dr. John Tokish and continued with an excellent program for the residents and fellows filled with a wide-ranging list of topics including tips about finding a job, setting up a practice, and getting more involved in AANA. We were so happy to also have
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some time set aside in the program to regale the audience with tales from our trip and, most important, to honor our godfather, Dr. John Richmond, for his contributions to the evolution of arthroscopic surgery, AANA, and the careers of so many young surgeons. That night, we all shared seats at the blackjack table with Dr. Farmer during AANA Casino Night. True, Dr. Farmer established himself as the most adept of us at the table, although several of us couldn’t help but wonder if he would be able to remain so cool, calm, and collected under different, “more realistic” circumstances. With our pockets empty of chips, it was time for a couple more “selfies” and a “so long” before it was time to make our way back to our rooms to pack and get home the next morning.
Los Gallos During the trip, Dr. Hernández-Pérez often educated us on Spanish colloquialisms. One of the group’s favorites was “no puede haber dos gallos en un gallinero,” which translates to “there can’t be two roosters in a chicken coop.” Yet, these 5 gallos made it work. When we started contemplating names for our class of traveling fellows, “Los Gallos” was among the first to come up, and it stuck. This incredible opportunity was truly a life-changing experience for all of us and one that will assuredly have an effect on our personal and professional development for years to come. True to form, AANA continues to demonstrate such a sincere interest
in developing its members through phenomenal programs such its traveling fellowship. We are all better surgeons for the time we spent observing master arthroscopists at work during our 2-week tour. But, more important, we are better people after this time spent with so many wonderful individuals. We are honored, proud, and humbled to have joined together to make this journey as the 2019 AANA traveling fellows.
References 1. Bills CC, Field ED, Field LD. "Double-row rip-stop" technique for arthroscopic rotator cuff repair. Arthrosc Tech 2017;6:e2053-e2059. 2. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: An in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004;32:1405-1414. 3. Bachmaier S, Smith PA, Bley J, Wijdicks CA. Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: A biomechanical full construct model. Arthroscopy 2018;34: 490-499. 4. Elhassan BT, Alentorn-Geli E, Assenmacher AT, Wagner ER. Arthroscopic-assisted lower trapezius tendon transfer for massive irreparable posterior-superior rotator cuff tears: Surgical technique. Arthrosc Tech 2016;5: e981-e988.
The 2019 Arthroscopy Association of North America Traveling FellowshipdLos Gallos: New Friends on an Old Town Road Fernando Hernández-Pérez, M.D., Michael H. Amini, M.D., Andrew J. Sheean, M.D., Aravind Athiviraham, M.D., and John C. Richmond, M.D.
Abstract: We came in with high expectations, yet the Arthroscopy Association of North America (AANA) Traveling Fellowship far exceeded them. The 4 traveling fellows came from different backgrounds, different parts of North America, and different practice settings, including an independent private practice, a hybrid private-academic practice, the military, and academia. We were lucky to have been ushered along the way by our godfather, the distinguished John Richmond, M.D., Past-President of AANA and Associate Editor Emeritus of Arthroscopy, who was gracious enough to give his time to the expedition. Over the course of the journey, this gang came together quickly and forged relationships that will last a lifetime. We are extremely grateful to AANA for the privilege and will cherish the memories for years to come.
W
e are so honored to have been selected as the 14th class of the Arthroscopy Association of North America (AANA) Traveling Fellowship. As many have described before, it was a once-in-a-lifetime experience. During the 2-week period, we had a unique combined experience of brotherhood and academia. This year’s fellows included Aravind Athiviraham, M.D., from the University of Chicago; Michael H. Amini, M.D., from The CORE Institute in Phoenix; Fernando Hernández-Pérez, M.D., from Alta Especialidad en Ortopedia in San Luis Potosi, Mexico; and Andrew J. Sheean, M.D., from the San Antonio Military Medical Center. It was such an honor to share this experience with John C. Richmond, M.D., Past-President of AANA and Associate Editor Emeritus of Arthroscopy, from New
From Alta Especialidad en Ortopedia (F.H-P.), San Luis Potosi, Mexico; The CORE Institute (M.H.A.), Phoenix, Arizona, U.S.A.; San Antonio Military Medical Center (A.J.S.), San Antonio, Texas, U.S.A.; University of Chicago (A.A.), Chicago, Illinois, U.S.A.; and New England Baptist Hospital (J.C.R.), Boston, Massachusetts, U.S.A. The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Received July 10, 2019; accepted July 15, 2019. Address correspondence to Michael H. Amini, M.D., The CORE Institute, 1500 S Dobson Rd, Ste 202, Mesa, AZ 85202, U.S.A. E-mail: Amini. [email protected] Ó 2019 by the Arthroscopy Association of North America 0749-8063/19874/$36.00 https://doi.org/10.1016/j.arthro.2019.07.012
England Baptist Hospital in Boston, serving as godfather. However, it was tough to keep up with his level of activity. He was the first one ready to go every morning and the last one ready to call it a night every evening.
Mississippi Sports Medicine and Orthopaedic Center Our first stage of the journey started on an Easter egg “hunt” on Easter Sunday from our hometowns all the way to Jackson, Mississippi, where Dr. Larry Field, current President of AANA, served as our host. The Mississippi Sports Medicine and Orthopaedic Center (MSMOC) team made arrangements for us to stay at the Fairview Inn, an incredible, recently renovated 1908 mansion. The members of the traveling fellowship had a staggered arrival into Jackson, with some arriving in time to enjoy Easter brunch at 1908 Provisions inside the Fairview Inn with Dr. Field and his wife Dr. Cindy Field. We had a great dinner with the Drs. Field, along with some of the other faculty and fellows from the MSMOC at Char Steakhouse, where we started our southern-diet culinary exploration. Our gracious hosts in Jackson ensured we stayed not only well fed but stuffed during our entire stay. Back at the hotel, we had the opportunity to get to know each other, enjoying a sip of red wine kindly provided by our hosts. On our first day, we witnessed a master class of combined efficiency and a minimalistic approach to deal with 2 massive rotator cuff repairs using Dr. Field’s described double-row rip-stop technique,1 2 instability
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cases with a Bankart repair and remplissage, and an arthroscopic tennis elbow surgical procedure, all of them finished by lunch with time to spare (Fig 1A). As usual, mealtime was spotlighted on our agenda. We went to a local staple, Keifer’s, for some gyros and a lively discussion on different topics like the use of the Latarjet procedure and the Bankart remplissage.
We returned to surgery, where Dr. Walter Shelton, another AANA Past-President, performed several interesting cases, including posterior medial condyle cartilage repair with microfracture through a posteromedial portal, 2 partial meniscectomies, and a very rare case of medial snapping knee due to an aberrant semimembranosus distal insertion. During these cases,
Fig 1. (A) Mississippi Sports Medicine and Orthopaedic Center, home to multiple presidents of the Arthroscopy Association of North America (AANA), with Current AANA President, Larry Field, M.D. From left: Fernando Hernández-Pérez, Past-President and Godfather John Richmond, Current President and site-host Larry Field, Aravind Athiviraham, Andy Sheean, and Michael Amini. (B) Photograph with PastPresident Walter Shelton, M.D. From left: Michael Amini, John Richmond, Walter Shelton, Andy Sheean, Aravind Athiviraham, and Fernando Hernández-Pérez.
AANA TRAVELING FELLOWSHIP
we had the opportunity to discuss Dr. Shelton’s 15 years of experience using quadriceps tendon autograft and catch some tips on transmeniscal portals, piecrusting the medial collateral ligament for tight medial compartments, and the safety and utility of popliteal tendon stitches when repairing a lateral meniscus (Fig 1B). In the afternoon, we came back to the MSMOC and experienced a great wet laboratory guided by Dr. Austin Barrett, exploring and reconstructing lateral and posterolateral corner structures using the LaPrade technique,2 followed by a posterior knee structure dissection, examining the posterior cruciate ligament, meniscal root attachments, and neurovascular bundle, as well as a review of different techniques of lateral extra-articular tenodesis. After finishing with the knee, we performed a Latarjet procedure, learning important tips from Dr. E. Rhett Hobgood about exposure and graft fixation, as well as a simple yet effective way to mount the specimen in a more anatomic position. We went back to the Fairview Inn to get dressed for another wonderful meal, at Koestler Prime, and a tremendous talk from our godfather entitled “The Journal of Retractions,” where he offered an incredibly candid appraisal of many of his contributions to the orthopaedic literature ranging from early experiences with thermal capsular shrinkage to the first description of a suture anchorebased Bankart repair. The next morning, we observed 3 great cases with Dr. Jason Craft, including 2 hip arthroscopies with labral repair and femoral neck osteoplasty, as well as a quadriceps tendon anterior cruciate ligament (ACL) reconstruction. He made it look so much easier than we were used to that he may have sparked the interest of
Fig 2. Learning about authentic mezcal. From left: Andy Sheean, John Richmond, Fernando Hernández-Pérez, Aravind Athiviraham, and Michael Amini.
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some of us, perhaps, in jumping into the hip arthroscopy world. We headed back to the MSMOC for lunch and our first academic program, which included lectures by the hosts and the guests that sparked lively debates about the current state of the art in controversial topics. We were also privileged to listen to another talk from our godfather, “Leadership by Example,” something all in the audience were eager to hear from such an accomplished teacher, mentor, and gentleman. That evening, Dr. Field hosted us at his beautiful lake house, where we had an amazing dinner and a night filled with friendship and camaraderie. The godfather gave our host, Dr. Field, and the fellows quarter-zip jackets, and the MSMOC staff were so generous in presenting each of us with a painting of the Mississippi River by Wyatt Waters, a renowned Mississippian artist. Dr. Hernández-Pérez then introduced the group to mezcal from his hometown, the first of many exposures during the trip (Fig 2). The next day, we had another filling breakfast and a morning conference on posterior cruciate ligament reconstruction from Dr. Craft before heading to the airport and making our way to Winston-Salem!
Wake Forest University We arrived at the Greensboro airport and settled into the Kimpton Cardinal Hotel in Winston-Salem, an awesome, historic building from 1929, once headquarters to R. J. Reynolds Tobacco Company and eventual architectural inspiration for the Empire State Building. That night, we met our host, Dr. Brian Waterman, a previous AANA traveling fellow, and had dinner at the Katharine Brasserie & Bar on the patio with the entire Wake Forest Department.
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Our next day started with coffee with Dr. Andrew Koman, Chairman of Orthopaedics, and Dr. Kevin High, President of Wake Forest Baptist Health. We split into 2 groups. Drs. Richmond and Hernández-Pérez went to watch Dr. John Hubbard perform an arthroscopic gluteus medius repair, an autologous hamstring ACL reconstruction, and a meniscectomy. Drs. Athiviraham, Amini, and Sheean spent the morning with Dr. Waterman. He performed a medial patellofemoral ligament reconstruction with an osteochondral fracture repair, an arthroscopic Bankart repair, a posterior capsulorrhaphy and subpectoral tenodesis, and a meniscectomy. We had lunch and then went to the David F. Couch Ballpark, where we had the opportunity to admire and even try its state-of-the-art motion analysis laboratory to break down pitching mechanics and understand how injuries happen. Here, we realized the limit of our pitching skills. Fortunately, there were no injured labra or rotator cuffs, just injured pride. We then had a glance at the future of medicine when visiting and admiring the work of Dr. Anthony Atala at the Wake Forest Institute for Regenerative Medicine. Remember the ear grown on the back of a rat? That was Tony Atala’s tip of the iceberg. The institute is 3dimensionally bioprinting organs in the laboratory from scratch. This visit opened our eyes to near-future applications of this technology in our field, such as 3dimensionally printed, cell-seeded scaffolds for reconstructing bone defects, musculotendinous units, and osteochondral plugs. That evening, we were hosted at the Forsyth Country Club by Dr. Gary Poehling, Chairman Emeritus at Wake Forest and Editor-in-Chief Emeritus of Arthroscopy, as well as the rest of the Orthopaedic Department. We enjoyed another evening of relaxation, fellowship, and a light academic program. The next morning, we watched Drs. Ben Graves, Kevin Coates, and Brian Waterman perform a multitude of arthroscopic cases, including several rotator cuff repairs, ACL reconstructions, and shoulder stabilizations. After surgery, we visited the Wake Forest training room and workout facilities, an all-inclusive facility with stateof-the-art technology, including blood flow restriction, isokinetic training, and low-gravity treadmills. In the afternoon, we met the Sports Medicine Department at Foothills Brewery and enjoyed a couple of samples of one of their local staples. We then spent the evening in the Wake Health Box at the Dash Minor League Baseball game. Dr. Waterman, who serves as team physician, took us through the locker room and training room, where we had a chance to meet the head athletic trainer and were presented with our very own Dash “swag” (game-ready, fitted hats!). On Saturday morning, we set out for Hanging Rock State Park for several hours of hiking and enjoying
lunch at a beautiful landmark including rocks and waterfalls. We then came back to the hotel for what seemed to be one of our few unscheduled blocks of time. We made our way to the hotel’s recreation center, where we found a half-court basketball court and decided to risk our ACLs and Achilles tendons in a twoon-two game where Dr. Athiviraham started his winning streak as team Athiviraham-Amini beat team SheeaneHernández-Pérez despite Dr. Sheean’s incredible efforts and athleticism. Grateful there were no injuries, we got ready for a special afternoon at the home of Dr. Poehling (Fig 3). We learned all about mallets and wickets and got ready to continue competition in a very fun croquet tournament on his regulation court. It was again Dr. Athiviraham, this time along with Dr. Hubbard, who took the top prize. Dr. Poehling then hosted us for dinner in his historic greenhouse that was rescued from demolition, moved to his property, and fully restored into a truly beautiful space. There, we enjoyed a delicious menu prepared on-site by chef Charles Paynter from Five Loaves Catering that was paired perfectly with a taste of North Carolina’s famous Raffaldini Vineyard. After dinner, we found our way to the Old Winston Social Club, where we continued the competitive spirit of the day on the shuffleboard tables, along with a table-sized pizza and a couple of beverages. This capped off quite a time in Winston-Salem.
Fig 3. Dr. Gary Poehling’s croquet court. The trip to Wake Forest was capped off with an evening croquet tournament followed by dinner inside the greenhouse (background) at Dr. Poehling’s house. From left: Andy Sheean, Aravind Athiviraham, Gary Poehling, John Richmond, Michael Amini, Fernando Hernández-Pérez, and site-host and prior traveling fellow Brian Waterman.
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University of Florida The next morning, we flew from Winston-Salem to Orlando, rented a car that could have fit 2 groups of traveling fellows, and drove to Gainesville, where we enjoyed a low-key dinner at Shula’s Steakhouse. The following morning, we were warmly greeted by our host, Dr. Kevin Farmer, yet another previous AANA traveling fellow. We had the opportunity to watch Dr. Farmer skillfully perform 2 ACL reconstructions (1 with boneepatellar tendonebone autograft and 1 with hamstring autograft) augmented with a FiberTape (Arthrex) as an InternalBrace (Arthrex).3 This was followed by an interesting rotator cuff repair in the lateral position. In the evening, we had the opportunity to listen to internationally renowned trauma surgeon Dr. Michael McKee, who was a visiting professor that day, give an insightful grand rounds presentation entitled “Clavicle Fractures: How Science Changed Practice.” For dinner, we were treated to delicious sushi at Dragonfly Sushi in downtown Gainesville, where we had the chance to taste some of the most delicious and original sushi creations, including butter-fried rib eye. We were fortunate to be joined by one of the great leaders of sports medicine, Dr. Pete Indelicato. We enjoyed listening to his interesting anecdotes from his storied career as head team doctor for the Florida Gators. The following morning, we had the opportunity to watch Dr. Bradley Schoch perform an impressive arthroscopically assisted lower trapezius tendon transfer4 for a massive irreparable rotator cuff tear. Following lunch, we had the opportunity to visit the “The Swamp” (i.e., Ben Hill Griffin Stadium) and the University of Florida Gators football team facilities. Looking at all the plaques highlighting the number of former Gators who went on to become NFL greats was truly awe-inspiring. The memorable stadium tour was followed by our academic program, where we had the opportunity to give our final presentations of the traveling fellowship. Undoubtedly, the highlight of our time at the University of Florida was the following day when we had the incredible and thrilling experience of riding on an airboat in the open marshlands along the Suwannee River (Fig 4). Dr. Hernández-Pérez was literally “blown away” by the powerful fan of the airboat. We also had the chance to enjoy choice beverages while listening to an engaging R&B/hip-hop music collection with the spectacular acoustics of the airboat. We all still fondly think of this moment every time “Old Town Road” plays on the radio.
Orlando and AANA 2019 Annual Meeting After that unique experience, we set out on the back roads of central Florida headed for Orlando, stopping at
Fig 4. Air boating in the Florida swamp. From left: site-host and prior traveling fellow Kevin Farmer, Aravind Athiviraham, Andy Sheean, Fernando Hernández-Pérez, and Michael Amini.
a truly unique spot for a taste of the local fare (Burger King), and arrived just in time to attend the President’s Reception, which took place in the center of the hotel in its island-themed grotto meeting space. We were honored to meet many of the AANA leadership and reconnect with Drs. Field, Waterman, and Poehling. It was exciting to finally meet Dr. Denver Stanfield, the chairman of the traveling fellowship committee, and share our amazing experiences on this traveling fellowship with him. We met many of the previous AANA traveling fellows, and it was inspiring to see how fondly they all still recall their own traveling fellowships, as well as the relationships that they forged along the way. The following day, we had the chance to attend an excellent scientific program, including captivating live operations and informative instructional course lectures. We were so honored to participate in Fellows’ Day, where the afternoon was kicked off by an inspirational speech by Dr. John Tokish and continued with an excellent program for the residents and fellows filled with a wide-ranging list of topics including tips about finding a job, setting up a practice, and getting more involved in AANA. We were so happy to also have
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some time set aside in the program to regale the audience with tales from our trip and, most important, to honor our godfather, Dr. John Richmond, for his contributions to the evolution of arthroscopic surgery, AANA, and the careers of so many young surgeons. That night, we all shared seats at the blackjack table with Dr. Farmer during AANA Casino Night. True, Dr. Farmer established himself as the most adept of us at the table, although several of us couldn’t help but wonder if he would be able to remain so cool, calm, and collected under different, “more realistic” circumstances. With our pockets empty of chips, it was time for a couple more “selfies” and a “so long” before it was time to make our way back to our rooms to pack and get home the next morning.
Los Gallos During the trip, Dr. Hernández-Pérez often educated us on Spanish colloquialisms. One of the group’s favorites was “no puede haber dos gallos en un gallinero,” which translates to “there can’t be two roosters in a chicken coop.” Yet, these 5 gallos made it work. When we started contemplating names for our class of traveling fellows, “Los Gallos” was among the first to come up, and it stuck. This incredible opportunity was truly a life-changing experience for all of us and one that will assuredly have an effect on our personal and professional development for years to come. True to form, AANA continues to demonstrate such a sincere interest
in developing its members through phenomenal programs such its traveling fellowship. We are all better surgeons for the time we spent observing master arthroscopists at work during our 2-week tour. But, more important, we are better people after this time spent with so many wonderful individuals. We are honored, proud, and humbled to have joined together to make this journey as the 2019 AANA traveling fellows.
References 1. Bills CC, Field ED, Field LD. "Double-row rip-stop" technique for arthroscopic rotator cuff repair. Arthrosc Tech 2017;6:e2053-e2059. 2. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: An in vitro biomechanical study and development of a surgical technique. Am J Sports Med 2004;32:1405-1414. 3. Bachmaier S, Smith PA, Bley J, Wijdicks CA. Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: A biomechanical full construct model. Arthroscopy 2018;34: 490-499. 4. Elhassan BT, Alentorn-Geli E, Assenmacher AT, Wagner ER. Arthroscopic-assisted lower trapezius tendon transfer for massive irreparable posterior-superior rotator cuff tears: Surgical technique. Arthrosc Tech 2016;5: e981-e988.