To Dr. Eduardo Arias, with deep respect and admiration.

A mentor is an exceptional individual who, through dedication and passion for his profession, successfully awakens a genuine desire to achieve excellence in us; modeling apprentices like a sculptor by way of example. The art of teaching is innate in him or her.

The mentors everyone wishes they had, nurture creativity, firmly remarking its own importance, for it provides dynamism to thought, and vitality to execution. They constantly urge us to find innovative ways to overcome difficulties. They do not limit knowledge to mere texts, for the greatest discoveries and inventions have been achieved by deliberating beyond text lines.

They invite you to reflect, perfecting their art through this act of introspection. They make an imprint, and encourage learning from mistakes, for they too are great mentors. They find success and failures within their planning by using a retrospective analysis of their actions, refining them for the benefit of progress.

They are self-critical, demanding, and perfectionist, for these qualities have led them and their disciples to reach state of the art.

The mentors everyone wishes they had, are attentive to the words of their students, considering their points of view. They find enriching contributions in each of their words, taking them as baselines for discussions that reinforce the competencies developed, also reflecting on how to respond to natural or simulated learning scenarios. They understand the importance of both the learning process and the benefits of cultivating this relationship.

They know when to remain silent, allowing their apprentices to learn to connect thoughts and considerations, and they patiently wait for them to find the answers. They share their own experiences as apprentices demonstrate their progress, and they know when to reward them by empowering them in their decision-making processes. Their own suspicion forces one to rethink what is being done, resulting in a modified approach to solving a problem.

They recognize the importance of theoretical knowledge for developing criteria, but always encourage practice, which leads to mastery. For example, they show how committed work and study lead to excellence.

They defend the universality of knowledge, conceiving it as free and within reach of anyone who decides to conquer it. They are detached and teach their art as it was once taught. They are not apprehensive about what they have learned along the way and can reveal every last detail and secret of their experience.

They are flexible. They allow improvisation over their education canvas, passing the wheel and providing company along the way, always attentive to the call of their pupils. A mentor knows how to draw a vast collection of skills wherewith to initiate their apprentices in the art. They trust the imparted criteria and allow the opportunity to use different approaches to reach the same goal. They encourage conflict resolution with the means at hand.

The mentors everyone wishes they had, empower their students’ skills and abilities. They keep their expectations high and inspire them to do better. Their demands increase following their students’ progress.

They respect individuality, acknowledge their scholars’ strengths and weaknesses, their individual work methods, their ways of responding to advice, and the diversity of their motivational needs.

They are an ethical role model. They inspire trust and respect, always available for advice and support.

The mentors everyone wishes they had, help you grow both professionally and personally.

Epilogue: The Dreyfus Model of Skill Acquisition

In the field of education, the Dreyfus model of skill acquisition explains how students acquire skills through formal instruction and practice. Brothers Stuart and Hubert Dreyfus proposed the model in 1980 in an 18-page report embodying their influential research at the U.S. Air Force Office of Scientific Research and Operations Research Center at the University of California, Berkeley.

The original model proposes that a student goes through five distinct stages: novice, competent, proficient, expert and master.

The novice is a student who follows the sequence of steps as they are delivered, without context, with no sense of responsibility beyond following a set of rules.

Competence is achieved when the student develops organizing principles to quickly access particular sequences of steps relevant to a given mission; thus, competence distinguishes itself by active decision-making in choosing a course of action in a given situation.

Proficiency is achieved when the student is able to incorporate his or her intuition into decision making and devises his or her own steps in given scenarios. Progression is, thus, from rigid adherence to rules to an intuitive model of reasoning based on tacit knowledge.

The five stages of skill acquisition can be summarized in the table below:

NoviceFollows specific rules in specific circumstances.
CompetentIntegrates contextual elements to applying rules; some degree of understanding and integration of their application is necessary. Handles a large volume of information and experience, which determines the need for organization and prioritization, following a mental framework of general guidelines.
ProficientAt this stage, the individual feels emotionally committed to the achievement and becomes more actively involved in the task, transitioning from rule-based decision-making to a particular action’s voluntary and conscious choice.
ExpertThe individual can recognize situational patterns without decomposing them into primary elements; in other words, it generates a multidimensional approach without carrying out a deliberate process, intuition.
MasterUnderstands what is happening at a deeper level and responds spontaneously and flexibly to complex situations. At this stage, understanding the problem and decision making is done without analysis, planning and discussion. The expert simply responds to the circumstances that determine it.

Figure 1.- Skill acquisition stages according to the Dreyfus model.

By Theodorakys Marín Fermín, MD QATAR.
Communications Committee, Young Professionals Task Force

Translation by María Teresa Toro.

The Women’s Soccer and Basketball Health Study: From Head to Toe

Public health research is filled with many examples of longitudinal studies that investigate health outcomes in select populations. The Framingham Heart Study predicts the development of cardiovascular disease in its study participants. This study has spanned 3 generations and expanded beyond cardiovascular outcomes. The Nurses’ Health Study investigates risk factors for chronic diseases in women. In sports, the Football Players Health Study focuses on the health conditions of retired NFL players. More recently, the Drake Football Study was launched to evaluate the health effects of male professional soccer players over a 10-year period from the end of their careers to retirement. Notably, both of these studies involve male athletes.

There is ample evidence to show that women are under-represented in the sports medicine literature. In a review of published articles in the American Journal of Sports Medicine, British Journal of Sports Medicine, and Medicine and Science in Sport and Exercise, the proportion of female participants was significantly lower than that for male participants, with an average male-to-female ratio of 2:1 in more than 1,000 published articles. This sex disparity does not align with the rise of female athlete participation, which has increased from 2% for the 1900 Paris Olympics to almost 50% for the recently-completed 2021 Tokyo Olympics. 

The principles of public health are based on prevention, protection, and promotion that apply regardless of the population. Building upon the long history of public health research and to tackle the male-centered literature, we have launched a study for retired elite female athletes in soccer and basketball, two of the most popular sport played by girls and women across the globe. The Women’s Soccer and Basketball Health Study investigates the risks and benefits of a career at the elite level (collegiate, semi-professional, professional, and national team) in 5 health domains: physical, musculoskeletal, female athlete, neurocognitive, and mental. 

While the association between knee injuries, particularly ACL ruptures, and premature osteoarthritis has been well-studied, the relationship between concussions and neurocognitive health in female athletes has not garnered the same amount of attention as that for American football and chronic traumatic encephalopathy (CTE). In our series of meta-analyses, women have higher incidence of concussions in soccer and basketball, are more likely to have ball or equipment contact as the mechanism of injury, and experience more recurrent concussions compared to men. 

The long-term impact of the Female Athlete Triad (menstruation, nutrition, and bone health) has also not been well-studied. More recently, the Triad has expanded to Relative Energy Deficiency in Sport (RED-S), which can impair several bodily systems, including the metabolic, immunological, and cardiovascular systems. As for mental health, we need look no further than Simone Biles and Naomi Osaka, two of the top athletes today, to see the toll of competing at the highest levels, not to mention the mental health issues related to injury and loss of athletic identity after retirement.

Rather than investigate one single area like most conventional studies, our wide-ranging study evaluates the whole player from head to toe. Furthermore, the health domains are likely related and should not be evaluated in isolation. We have designed the study to use the shortest validated questionnaires possible in each of the health domains, enabling us to cover a lot of ground in an average time of 10-15 minutes for completion of the online anonymous survey. Former players have the power of hindsight, which will be used to look ahead to prevent injuries, protect future generations of female athletes, and promote a lifetime of sports participation. While Equal Pay has been a rallying cry for the progress of women’s sports, it is also time to add Equal Health to the discussion.

Links to the survey can be found below. We are currently looking for international collaborators to conduct this study on a global scale and to plan for future prospective studies.



Daphne Ling, PhD, MPH

Dr. Kamali Thompson: From Olympics to Orthopaedics

In an interview for the ISAKOS Podcast, Dr. Stephen Lyman and Dr. Laurie Hiemstra were able to interview Olympic Fencer and Orthopaedic Surgeon, Dr. Kamali Thompson.

Q: Maybe you could tell us a little bit more about yourself!

A: When I was really young, like, I know a lot of people have aspirations to become something and if you told me when I was ten I would be an orthopedic surgeon and an Olympic fencer I would be like “That’s crazy!”, so it’s really cool to get here.

A really brief story about how I got to where I am today, fencing wise, I started fencing in high school which is pretty unusual. Fencing is one of those sports where people start when they’re like six or seven and by the time they’re in high school they’re trying to figure out what college they are gonna go to and maybe go to a couple of World Cups when they’re around thirteen, fourteen, or fifteen and I started fencing in high school. I had no idea what was going on. I had no idea you get a scholarship for fencing. My mom found out from my fencing coach that it was really good to fence and you could probably get a scholarship and might be able to get into an Ivy League school. So she said “All right. Well, I’m going to sign you up for the team and you don’t really have a choice.” so that’s why I started fencing.

After a couple of years I started in New Jersey, which is kind of the Mecca of high school fencing. After a couple of years I was really tired of these girls beating me so I found a fencing club in New York City. All of the fencers there were at minimum a national champion. We have a lot of Olympians. Two and three time Olympic medalists and they all go to top rated schools too so I think that was my opening to the Olympic world.

I got a scholarship to Temple University and I kept fencing there and after college was over I knew I wanted to go to medical school, but at the same time I didn’t really feel like I did anything so I decided to just start training for the Olympics while I was in medical school and see how it goes. This year I ended up fifth in the country. The top four people go to the Olympics and I am the first alternate. That’s really exciting, so all my hard work paid off I’m going to Tokyo in a couple of weeks!

On the orthopedic end, I always wanted to be a pediatrician. When I started fencing I actually got “Skiers Thumb” and I was really upset about it. My doctor didn’t really seem like he cared too much and I was like, “You don’t understand. I’m trying to go to the Olympics and my fingers feel that you feel like it’s about to fall off!” so it was that moment I decided I should do something in sports, but I didn’t think I would like surgery that much because I really wanted to do Pediatrics. I just happen to do my surgery elective my third year Med school and I really liked it! I picked the ortho elective because I thought it would be really interesting to see like the sports medicine side of that and on my first day my attending handed me a drill and he said “Well, put this screw in someone’s femur.” I said “This is crazy and I love all of this! So how can I become an orthopedic surgeon?”. That’s how I am a fencer and an orthopedic surgeon today.

Q: How do you think your sport prepared you for residency or do you think your sport has helped you prepare for residency.

A: Yeah definitely! Fencing is constantly testing your confidence and constantly testing your preparation. If you show up to the strip and you don’t really believe in yourself or you have not thoroughly prepared for your bout, whether it’s in practice or a video review, you’re probably gonna lose. So I feel like it’s really similar to residency where you have to come every day. You have to be ready. You have to study the night before and then, when you’re put into these situations, you have to be confident about what your preparation and your skills and your training. I think both of those things have really prepared me and some other little things here and there I’m sure will also help.

Q:  In the United States, only 6% of Orthopedic Surgeons are women. What is it like in fencing? Is it pretty equal between the sexes or is it rare?

A: It’s pretty equal, I think. In general, men events usually have a little bit more. For example, I fence saber. When I fence in women saber events we have maybe 170 or 180 people. My brother fences saber as well.  He’s on the Olympic team. He’s number four in the country, so that’s pretty exciting. He had maybe 200 people in his event so we’re pretty balanced. A little less women than men, but it’s definitley not uncommon for women to fence.

Q: You grew up in New Jersey. Can you tell us a little bit about your childhood?

A: I was born in Los Angeles, CA. We moved to New Jersey when I was in 3rd grade. I actually skipped first grade and I started school early so I’m two years younger than everybody else in my class which was really awkward at times growing up because I was just so far behind. I didn’t drive a car when I was in high school I was too young. I didn’t vote until two years into college. I have a younger brother who fences as well. Both my parents moved us to New Jersey when I was in 3rd grade. Not really expecting anything amazing out of like me or my brother, but just wanted to raise us in a really great area. We lived in a very diverse town and I think that just been so amazing for me growing up because I really enjoyed different cultures. With fencing, we traveled to all these countries and I’m really privileged to see all that. I enjoy being around a bunch of people who look like me and who don’t look like me. I love learning about other cultures.

I chose to go to our public high school and it’s just really funny that we have a fencing team because normally fencing programs are for prep schools or private schools. We’re a very normal public school and we have a hunting team and when I was in school we were top 16 in the state so we were really amazing. I think it’s been great to grow up in a place where there’s a lot of like regular people and we just end up doing really amazing things so a lot of my friends have also gone to do great things and we all just come from New Jersey.

Q: How did you figure out your time management? How did you figure out your priorities? Is that something comes naturally to you, because clearly you juggle more than most people.

A: I was always pretty decent at time management. I wasn’t really a huge procrastinator in life. I was a dancer prior to fencing, so I was pretty used to doing something after school or doing something on the weekend and then coming home and doing my homework. The same thing happened when I got to high school and started fencing. My junior year, when I joined my fencing club, I started fencing in New York City, so that was way more complicated than just going to school. I didn’t get home till 8:00 or 9:00 PM and then I still had all this work to do. I carried those principles of figuring out how to get my stuff done quickly to college and I remember my freshman year of college maybe a month and a half and I was really upset, because, I mean we’re in college, so everyone’s out. Everyone’s hanging out. Everyone is partying. Here I am, doing my homework and I was like “This is not fun. I’m not having as good time as everybody else is.” I remember calling my mom and she said “Keep staying focused. Keeping being disciplined and you’re gonna see, really quickly, it’s gonna pay off. Other people who are maybe having more fun than you, it’s gonna affect them in the long term.” I saw that by midterms.

From there I think I just had to figure out the social aspect. How can I balance it so I’m getting my work done, getting practice done, but I’m still like seeing my friends and stuff? So I kind of perfected that at the end of college. Then once I got to Med school… You know they say medical school is like drinking water out of a fire hose, and they are not lying. But, I feel like my skills were so good by that point I was just really disciplined. I schedule everything like a crazy person. It kind of just got easier from there.

Q: What are you looking forward to the most when you start residency?

A: OK, so, the real answer is seeing patients and not having to leave and say “I’m going to go get the resident.” because I am the resident. The second answer is, I’m really looking forward to my long white coat. I’m really looking forward to the food and having my meal swipes, because it wasn’t always so inconvenient to have my debit card.  I’m really excited about that.

Q: What are you most anxious about?

A: Not knowing everything. I think I have to get really comfortable not knowing everything.

Q: Do you have any mentors in fencing or orthopedics?

A: Yeah, I mean, mentorship is incredibly important and that’s definitely why I am where I am today and who I am today because I’m at my because of my mentors. It really all comes down to the same five or six people. My high school coach, number one. Who is the person who told my mom that I should start fencing. My fencing club is huge network of mentors of people who have been amazing athletes and amazing students. They’ve all gone off really great colleges and some people have gone off to Business School. I think just having these people who have gone through this before so I wasn’t the person the first person in my club to get a professional degree while I was fencing. I had mentors to reach out to. Then my mentors introduced me to my coach at Temple and she is… I love her! She started fencing when she was in high school she went on to become a two time Olympian. One of my coaches introduced me to an orthopedic surgeon who also fences. He’s the person who introduced me to sports medicine an introduce me to my research family at NYU and was a really big mentor in the beginning of my orthopedic journey.

Q: Do you have any last thoughts you’d like to share?

A: Yes, definitely! I always tell people that, I think, the best part about my story is that when things looked really bleak, the only reason I got through was because I decided to give something a try. I had no idea I was gonna be good at fencing on an international level. When I entered medical school I just decided to try it and see what happens. I know a lot of people always ask me “What’s the key to success?” and I think if you just try and please don’t give up, especially after that first failure, you just keep pushing through, I think a lot of things will workout.

Q: Do you have any words of advice you would give to young women about your journey and what it is like to actually get into orthopedics?

A: Yes! Don’t be intimidated by what seems like it might be impossible. Don’t be intimidated by any negative words that people might say. I know when I was in my rotations people would look at me and kind of say “Oh you must be in another specialty.” and I would say, “Oh, I’m actually applying for ortho.” Don’t let all those like little microaggressions get to you. Don’t be afraid if you’re interested in ortho and you’re interested in something that’s really competitive. Go for it and just figure out what you need to do to get in there. Then just get a good support system and it’s all gonna workout great.

ISAKOS Launches Young Professionals Task Force

ISAKOS has recently launched the Young Professionals Task Force chaired by Dr Pieter D’Hooghe. The committee comprises 38 members from around the world, who are tasked with a shared mission to “promote membership to younger surgeons, foster emerging leadership, and increase engagement across strategic areas such as education, research, publications and governance”.

Although the task force is in its infancy, many of you will be familiar with their early work. Most notably, the recent webinar entitled “The Anterolateral Ligament: Let’s Stick to the Facts!”, which was very well attended, with nearly 2000 attendees. The webinar provides a comprehensive and up to date resource, with talks from international leaders in the field providing the latest insights on the anatomy and biomechanics of the anterolateral structures, and a strong focus on clinical results, imaging and surgical technique. This excellent resource is available along with other recent webinars via the ISAKOS global link. 

Behind the scenes, the Young Professionals Task Force has been equally busy with other aspects of its mission. One of the main objectives has been to promote membership to younger surgeons. Currently, membership is free for residents and fellows, so please help us to raise awareness and encourage your junior colleagues to apply. Membership brings a whole host of benefits including access to Global Link: the ISAKOS Online Education Portal with access to more than 3,000 media items, discounts at ISAKOS approved courses, access to the ISAKOS Career Center and Professional Resource Opportunities, and a subscription to the Journal of ISAKOS (full list of membership benefits here). 

Over the next few months the Task Force will be working on some exciting new benefits for our younger members including a new virtual mentoring program. Look out for an update soon and details of how to apply!

-Adnan Saithna 

Benefits of ISAKOS Membership include:

COVID-19: A Worldwide Human Perspective

Daniel A. Slullitel
Instituto Jaime Slullitel Sanatorio de la Mujer, Rosario, ARGENTINA

Mankind is confronting a unique moment. A single threat  is testing all countries in the world. Each country is facing  similar challenges that are influenced by its geography,  cultural, political, and economic background. 

Science is, indeed, helping us in very different ways—mainly  by trying to minimize health damage, by limiting propagation  of the virus, and of course, by searching for a cure. On the  other hand, the Internet is keeping us informed during this  period when close human contact should be kept minimal.  We are facing changes on our daily life: our freedom of  circulation is being jeopardized and limited in order to restrain  the spread of the virus, our contact with patients is modified  or nullified, and our souls are hit by fear of having the disease  and being contagious to others. Governments have taken  different strategies, but who knows whether these strategies  are right or wrong? 

In 2020, the ISAKOS Education Committee, with the full  support of the Executive Board, employed its intrinsic  worldwide-reaching capabilities to host a series of webinars  focused on helping the global community. In each webinar,  COVID-19 was present not as an educational subject but  as the subject of an informal conversation between distant  friends. During these conversations, it became clear that  while the threat (COVID-19) and the associated worries  are the same everywhere, the ways of fighting the virus  are different. 

We asked friends from around the world to share their  personal experience of this outbreak and have been honored  with their written responses in spite of their tight pandemic  schedules. 

Jeffrey S. Abrams
Seton Hall University, University Medical Center of Princeton, Princeton, New Jersey, USA 

The corona virus has been a unique and frightening event all  over the world. In the United States, the New York and New  Jersey regions were the first to be severely affected. In the  early months, many individuals died because of the lack of  knowledge on how to treat the respiratory distress syndrome  and organ failure. Although many COVID-19 patients were  older, many younger health care workers were affected as  well. This disease is very infectious and requires protective  spacing to limit the spread. The availability of hospital beds,  particularly ICU beds, was a problem. Our postoperative  recovery room became a COVID Unit monitored by the  anesthesiologists. 

At this time, we are in a much better place, and the number  of hospitalized patients with COVID has decreased. We are  better equipped with knowledge, and it seems rare that  someone dies of this virus. Work for an orthopaedic surgeon  has returned to elective surgery in the surgery centers and  hospital. Total joint replacement, arthroscopic, spinal, and  extremity surgery schedules are about 85% full.  

Patients still have the fear of what may happen to them  during surgery, and both patients and staff continue to take  precautions regarding spread. 

The major differences in our lives have been social. Children  are home. Restaurants are closed or only allow limited  outdoor seating. Many individuals are working from home  or are unemployed. There is very little traffic because of  these circumstances. The beaches are pretty full as many  continue to look for enjoyable ways to spend their time. We  are optimistic and look forward to life returning to what we  remember 6 months ago. My suspicion is that this will take  another year. Hopefully, next summer will be different as  normal activities are resumed, people return to work, world  travel picks up, and the family unit returns to normal. 

Julian A. Feller
OrthoSport Victoria Research Unit, Epworth Richmond, Melbourne, Victoria,  AUSTRALIA

In terms of the COVID-19 pandemic, Australia has been  fortunate compared with many other countries. Being an  island, we were able to close our borders relatively early, and,  with only medium-density living conditions, even in the cities,  outbreaks never reached the levels seen in other countries.  In addition, our health system is well developed and was  relatively easily ramped up to deal with an influx of patients  that fortunately never arrived. 

So things should be good. Indeed they are, at least in some  parts of the country. But government responses are going  to leave an enormous economic burden, and it may be that  the “cure” may end up being seen to be worse than the  disease. COVID-19 has exposed some interstate rivalries  and jealousies that are deeper than many had realized and  that go far beyond the banter of interstate sporting rivalries.  Australia is a federation of states. Health and education are  state, not federal, responsibilities, whereas aged care is a  federal responsibility. So there is plenty of room to shift the  blame when needed. 

The early governmental response in February and March  of 2020 may come to be seen as excessive, especially  when compared with the current position of countries such  as Sweden, which took quite a different approach. But it  was understandable and certainly not unreasonable given  the uncertainty as well as the dire predictions from some  modelling, and it may have been a factor in our limited  caseload. Case numbers and fatalities never soared and  settled quickly. 

But here in the state of Victoria, a so-called second wave  (or “phase” to use the currently preferred term) arose out  of poorly conceived and poorly implemented protocols  and procedures in quarantine hotels. This factor was  compounded by the fact that many of the security personnel  came from lower socioeconomic backgrounds and local  communities that were very susceptible to spread of the  virus. This situation subsequently led to outbreaks and, not  surprisingly, increased fatality rates in aged care facilities. 

The state government reacted with what can only be  regarded as a panicked response. Not willing to admit their  role in making the decisions that ultimately allowed the  second phase to occur, they became obsessed with driving  the numbers of cases to unrealistically low levels, such as  0 daily new cases. This approach led to a second round of  restrictions and lockdowns. Compulsory wearing of masks  away from home, a curfew from 8 p.m. until 5 a.m., 1 hour of  exercise per day (which has now been increased to 2 hours  per day), no leaving home for other than a few reasons, no  travel beyond 5 km from home, no visiting other houses or  meeting friends, no attendance at schools or universities, no  sporting activities, and essentially no elective surgery. The  police presence is high, and fines for breaching restrictions  are steep. Some have questioned how our civil liberties  appear to have evaporated so easily and with so little outcry.  People have become polarized in their views, and it is all too  easy to be labelled as being in one camp or another. 

As I write this, we are in the eighth week and our average  number of new cases per day is in the low 30s (yes, 30s, not  even 300s, despite the fact that Victoria has a population of  5.7 million). Hospitals have 50% bed occupancy, with only a  handful of COVID-19 cases, and operating staff are looking  forward to next week when we can at last recommence  some elective surgery. People want to be able to work. 

The effect of this second lockdown has been profound.  While we accepted the measures the first time around, there  is growing anger and resentment this time, especially when  life in other states is quickly returning to normal. We have  become a pariah state, with strict border closures imposed  on us, in part driven by parochial politics and upcoming  state elections. Quite apart from the impending economic  destruction, the community is losing its spark. People are  becoming less motivated, and depression and anxiety are  on the rise. It is particularly difficult for those living on their  own and those with young children living in confined spaces.  Obesity (so-called COVID fat) is visibly increasing. Selfishness  is growing, not lessening. Young people wonder how they  will find employment. Few can contemplate the enormous  financial cost and the level of debt that governments  now carry, perhaps 10 times levels previously thought  unacceptable. And for many rural communities, this comes  on top of the devastation of last summer’s severe bushfires. 

In orthopaedics, this year’s crop of final year trainees are  unable to look forward to overseas fellowships, but there  are no obvious jobs for them here next year. Surgeons  in their early years of practice feel like they are back at the  start. Those in sports surgery can’t expect to see any sports  injuries in the next 6 months. Surgeons nearing the end of  their practice may find that retirement comes just a little bit  earlier than anticipated. 

Our problems are by no means unique and, in comparison  with many parts of the world, they almost pale into  insignificance, although it is sometimes hard for individuals to  see that. We are a lucky country, but we have not escaped  the effects of this virus or the effects of our response to it. 

Margaret W. M. Fok
FRCSEd(Ortho), MBChB 
Queen Mary Hospital, The University of  Hong Kong, Hong Kong CHINA 

Because of the proximity of Hong Kong with Mainland  China, measures to control the spread of COVID-19 were  started in late January 2020. With many locals still having  the experience of SARS (2003) fresh in their memories,  members of the public diligently started their preparation  and precaution by stocking up food, cleaning their homes  with bleaches, and wearing face masks, without being  commanded by the government. Despite it being the start of  the celebration of Chinese New Year, social gatherings were  kept low.  

In hospitals, many elective procedures were cancelled at  the start of February 2020, with the priorities being given  to emergency, trauma, and oncology procedures. Hospital  staff were reminded by infection-control teams to be vigilant  in terms of hand hygiene. Protective gear was given with  specific instructions on how it should be put on and taken  off in order to minimize the chances of contamination and  infection. Some of the surgical wards were emptied and  were converted to negative-pressure wards in preparation  for potential patients with COVID-19. Measures were  established for the management of patients with COVID-19  who needed emergency operations.  

Although the number of confirmed cases each day was  kept low (mostly <50) in this city as compared with the rest  of the world, the public has remained vigilant in terms of  mask-wearing and hand hygiene. Because of the population  density, the public understand that any spread in the public  may be disastrous. As a result, we have succeeded in not  having any lockdown and only a minimal number of health 

care workers have been infected with COVID-19 by working  in the public hospitals. 

We have gradually resumed elective procedures, although  there was a period during which we kept the number of  turnovers in the hospitals low (i.e., by performing one long  procedure instead of a few shorter procedures). Zoom  meetings and webinars have become the norm, and medical  students have had to adjust to virtual learning.  

With the borders being closed since March 2020, the general  public has missed travelling. Yet, this enables people to slow  down, spend time with their family, enjoy nature, and enjoy  what the city has to offer.  

Eiji Itoi
Tohoku University School of Medicine, Sendai, JAPAN 

The first case of COVID-19 in Japan was confirmed on  January 15, 2020, and the first case in my prefecture, Miyagi,  was reported on February 28. As of September 1, 2020,  we have 67,865 cases of COVID-19 nationwide and 207  cases in Miyagi prefecture. I work at a university hospital,  a designated infection-control center. Many coronavirus  patients have been admitted to our hospital. As a result,  we needed to maintain the number of staff members in the  infection unit. To that end, the Hospital Director issued a  couple of orders: (1) procedures requiring postoperative care  in ICU or HCU should be postponed because we need to  keep the number of personnel in the infection unit (most of  whom are from ICU and HCU), and (2) elective procedures  should be postponed because of the lack of surgical gowns  and masks. Between mid-April and mid-June, we performed  no arthroplasties, no rotator cuff repairs, and no Bankart  repairs; we only performed procedures for malignant tumors  and paralytic / paretic cases. We are gradually resuming  elective procedures. All patients must undergo mandatory  PCR testing for COVID-19 before surgery in our hospital.  In terms of the number of new cases (as of September 1,  2020), we are in the middle of the second wave. The death  rate caused by this virus is 1.9% in Japan. The problem is  that the more patients we accept, the worse the financial  status of our hospital becomes. We are requesting the  government to support the institutes in which coronavirus  patients are being treated.  

My professional life has changed dramatically. I used to travel  abroad to attend international meetings and invited lectures  almost every month. In addition, I used to travel extensively  for domestic meetings and lectures. All of these activities  have been cancelled, postponed, or changed to virtual.  In January of 2020, everything was normal; I attended the  Board-Certified Examinations of Japanese Orthopaedic  Association in Kobe (a 1.5-hour flight from Sendai) as well as  two local meetings in Sendai. However, the first coronavirus  case in Japan was found in January and the cruise ship  “Diamond Princess” was anchored in Yokohama harbor in  early February after a passenger tested positive for the virus.  The virus was confirmed in one passenger after another,  ultimately affecting >700 passengers from this cruise ship. A  great fear of the virus rapidly spread throughout the country.  In early February, I had a plan to attend the Nepal / Japan  Combined Orthopaedic Symposium in Kathmandu, Nepal,  but, because of the fear of coronavirus, I cancelled the trip.  I also was invited to the International Biennial Congress of  Iranian Society of Knee Surgery, Arthroscopy, and Sports  Traumatology in Kish Island, Iran, in mid-February, but that  meeting was postponed because many invited speakers  started to cancel their trips. From February 2020 until now  (September 2020), I have not traveled anywhere in the world,  not even to Tokyo; I have just stayed at home and continue  to go to my university on a regular basis.  

Of course, I have no schedule on my calendar during my  travel period. That means I have more time to concentrate on  my own work. As I am retiring from the university next March,  I am writing a monograph entitled “Shoulderology: It’s Fun to  Solve Clinical Questions and Know More About Shoulder” to  give inspiration and encouragement to the young generation.  Because of this pandemic, I have been able to spend most  of my time during the last 6 months writing this monograph,  and finally I have completed the draft! This was a great  blessing for me.  

In our department, a weekly clinical conference has been  held on-line since March 2020 in order to maintain social  distancing. Professors’ ward rounds and weekly journal club  meetings have been cancelled for the same reason. We have  very limited contact with each other. Tuesday is my clinic day.  The number of patients coming into the clinic has decreased  because of the fear of catching the virus. Every week after  the clinic, I have lunch with a doctor who helps me to fill out  the patients’ electronic charts. In the staff cafeteria, we sit at  a table with an acrylic board between us. This looks quite  strange, but this is our new lifestyle.  

Our daily lives have changed as well. I have not dined out  with my family or with my colleagues for the last 6 months.  In other words, I have had dinner with my wife at home every  day for the last 6 months. This never happened during 34  years of marriage. It is the same for my colleagues. I have  made it a rule to go grocery shopping with my wife every  Saturday. The grocery stores have placed hand sanitizers  at the entrance and at the exit. They have separated the  entrances and exits to promote social distancing. Whenever  we go outside, we are asked to wear a mask. This summer,  the beaches and pools were closed. We could not go  anywhere. Instead, we have much time at home, reading  books, watching TV, listening to music, and weeding in the  backyard during the weekend. I think most of my colleagues  and their families are more or less the same. We have now  more family time and less social time. Now is the time to  consider how to use this newly allocated time of our daily  living more wisely and fruitfully because we never know how  long this pandemic will last.  

Manuel Mosquera
Clinia la Carolina, Bogota, COLOMBIA

It happened 7 months ago, but it seems like yesterday. I  was in Santiago de Chile as a participant in our SLARD  international congress, and the news media from around  the world was talking about the dire situation, with Italy and  Spain trying to control the spread of coronavirus and the high  incidence of death. I remember sitting in a café with some  friends from Spain who were attending the congress as  speakers; we had all heard the rumors that Chile would close  its borders and my friends began to worry that they would  not be able to return to their families. My advice to them was  they had to leave Chile as soon as possible even if they could  not give their lectures; fortunately, they did so and returned to  Spain that same night.  

Early the next day, Chile’s president announced its closure  of its borders to Spanish people! My friends had made the  right decision; meanwhile, I started to worry about my return  to Bogota that was scheduled for the next Saturday at 15:00  hours. After the conclusion of the congress, we were able  to take our flight to Colombia. Because I felt exposed to the  contact with many people during the meeting and in the  airport and plane, I decided to isolate myself for two weeks  in order to prevent any risk of exposing my family, coworkers,  and friends. Nobody understood my decision, and all argued  that it was hasty, but when the days began to pass and the  news of multiple cases of COVID were present in Bogota,  they understood my reasoning. 

My isolation coincided with the quarantine decreed by the  government, which meant that I had to close my office and  surgery for 3 months. Having so much free time motivated  me to work every day on my action plan as president of  SLARD in conjunction with the executive committee and  the new board of directors. As a result, we quadrupled the  number of members, we included all orthopaedic societies  and / or associations related to the objectives of the SLARD  to be inclusive of all Latin American countries. We spent  2 months developing webinar programs and invited our  colleagues from all countries to participate in conferences  focusing on topics that are controversial in our professional  practices, with international colleagues from different  continents serving as opinion leaders. We also began to  develop a new website in accordance with the needs of  our society and launched our SLARD e-newsletter, which  focuses on news from the society, clinical cases, surgical  techniques, and so on. Finally, we defined the dates of our  congresses in Panama and Cartagena for 2021 and 2022,  respectively.  

During this unprecedented period in our academic  history, we were able to refine 5 consensus statements  on controversial and frequent topics, with final round of  discussions scheduled to take place during the first Latin  American Meeting of Arthroscopy, Joint Reconstruction, and  Sports Trauma, to be held in Panama on July 29-31, 2021. 

While I learned many things during this long isolation, one  of the main lessons is that we are very fragile because a  microorganism that we do not even have the ability to see  has put all of humanity at high risk, killing many people  without warning. I also learned that simple things are full  of value in our daily lives. We don’t need a lot of money to  be happy, because luxuries in these circumstances neither  make sense nor have value. But perhaps the best lesson  of this pandemic is to reaffirm that nothing and no one is  more important than God and family, which in our life before  COVID was left in the background because we believed that  our jobs are the main thing. How wrong we were!

Joan C. Monllau
Barcelona (Spain)

The outbreak of the pandemic last March caught me as I was about to board a flight to Santiago (Chile) for the SLARD Congress. The experience at the start was devastating with cases rising daily. The city of Barcelona was put on lockdown while our orthopaedic department had to switch its activity to mainly carrying out only non-operative care and handling trauma cases. We also started doing telemedicine visits. Besides stopping all elective orthopaedic activities, we faced hundreds of new patient admissions every day that called for opening new ICUs and had issues with the supply chain providing the much-needed personal protective equipment. Much more dramatically, we were even discussing limits on sedation and the antibiotics policy. Our colleagues from Internal Medicine were conjecturing and discussing how to come up with treatment plans for our own institution. We, as orthopaedic specialists, did not really know what we had to do to treat those patients.

Therefore, we went back to the medical school and started to learn medicine again. It began by us getting familiar with the stethoscope and even with ventilators and recognising populations at higher risk, etc. We also learnt new terms like “herd immunity”, “case count” (tracking the number of Covid-19 infections) and “return to normalcy/transition to normal” that had rarely been heard before. 

Nonetheless, we needed to stay positive and think the situation was just temporary. It might seem like a long time, but there was light at the end of the tunnel. We believed that this crisis would promptly end and we would be together as one, again. 

We found opportunity in this crisis as well. We kept connected and discovered several virtual ways to continue the pursuit of education. In my opinion, what we have learned is that we do not have to be afraid of the virus when we are well protected and follow social distancing rules. Above all, we should be prepared for the next wave that may already be upon on. In the hope of a safe and effective vaccine in the near future, we need to be aware of and learn more about the virus’ behaviour. 

Last but not least, I wish to express my deep gratitude to the medical community, particularly those in the front line, for their tireless dedication to patient care during this unprecedented COVID-19 pandemic.

Diversity – Life as a Latina Orthopaedic Surgeon

All my life I knew I want to be a doctor; I remember my grandmother in the emergency room and that is where I convinced of what I wanted to be.

During my years in medical school, was not clear about which specialty to do, I felt that I went through all of them but that they could not fill me completely, so when I graduated my first option was to be an Infectologist, in Peru and in many Latin American countries we did a year from rural service to be able to apply for a specialty, and I went to a place in the Andes of Perú, completely deserted, where I was the highest authority in Health (a recently graduated doctor) and where domestic violence was daily bread. It was thus that I had many cases of open fractures, which we could not  treat in my health center, and we had to transfer the patients for approximately 6 hours so that they could arrive at a hospital and had a surgery, I remember a lot that the Orthopedic Surgeon of that Hospital didn’t have an assistant for the surgeries and he asked me for help, I agreed a few times reluctantly, trauma was not in my plans and little by little when I saw the recovered patients. I liked it so much that I just waited for more patients to arrive to operate them!

When I applied for the residency, I had decided that I wanted to be an Orthopedic surgeon, and when I entered my hospital there was only one female attending and I arrived after almost 10 years without a female presence.

I never considered that as a woman I was going to have another treat, but it was, the first months were not pleasant, but little by little my work spoke more about me than my gender. My great teachers are men and thanks to them I sought to specialize in knee surgery. Until now, I cannot deny having suffered from bullying and sexual harassment, but I can say that they were isolated moments overshadowed by the good memories that I have and led me to the path where I am now.

“Until now, I cannot deny having suffered from bullying and sexual harassment, but I can say that they were isolated moments overshadowed by the good memories that I have and led me to the path where I am now.”

Probably this story you heard so many times and you feel identified with it, no matters the age that you have or where you came from, or in the other hand this could be so far of what you lived,  also could be that our environment is different. Latin America has 14 countries considered to have the highest rates of gender violence in the world, according to a UN survey in 2018 and Brazil and Mexico with the highest number of cases in the region. These not inconsiderable data tell us about a sexist society, where as a woman aspiring to have economic and emotional independence can put our lives in risk. Where our governments, despite implementing laws that classify the crime as femicide, impunity for these crimes continues.

This story is not only now. Throughout history, women have been restricted from access to education and work due to socio-cultural stereotypes that prevail to date. In a region like Latin America with a high rate of femicides, high costs of living and little access to management positions, we wonder what we can do to face this panorama.

It is increasingly common to see more women in medical schools. The proportion of women students has been rising over recent years, In 2015 from 46.9% to 49.5% in 2018. In 2019, women were around 50.5% of all medical school students, however, Orthopedics and Traumatology continues to be dominated by men many times due to canons created to require more strength, a factor that has already been shown is not decisive due to the innumerable technological innovations, the Not being able to achieve a balance between work and family, more than 40 hours of work a week, night shifts, surgical shifts that with good family support and a team work can be balanced, and also due to the lack of female mentors during the career. Reports in Australia revealed that 72% of students did not choose trauma because they did not have female tutors who were referents in the specialty.

Year after year we have been able to overcome difficulties, but there comes a moment of loneliness and that is where we look for solutions, this is how great projects arise and the need to be a strong group allows that different associations born, In Latin America, Chile were the pioneers with their Female Orthopedic surgeons founded in 2019, Females represents the 6% of all the Orthopedics Surgeon of their country. In Peru from 1634 Orthopedic surgeon, only 87(5.3%) are females, and in the lately 2019 was founded the Peruvian Association of female orthopedic surgeons.

Both to achieve greater participation in the specialty, a support and incentive group to achieve professional and personal development, through academic activities such as webinars, or achieving reach and interactions on social networks.

So far, countries such as Colombia, Mexico, Ecuador, Bolivia, Argentina, Brazil, Nicaragua, Guatemala, with the name “orthowomenlatam”, with collaboration of our older associations (Chile and Peru) are attracting attention with the organization of monthly academic activities with entirely female panels, putting the eyes on us.

All these initiatives are born with the spirit of power not only to empower ourselves as women and professionals, but also in an academic and scientific effort, through mentoring, collaborations and the recruitment of medical students for the specialty, as well as promoting training during and at the end of the residency. We developed an annual plan, which involves a monthly presentation with a female speaker, a symposium with workshops and lectures, our journal club and a project to involves medical students who want to became Orthopedic surgeon. We have a WhatsApp group where we can discuss any difficult case and exchange scientific articles as well, we have medical students that every day is involving with this project. Also not all is academic, we organize every month  social meetings, nowadays because of the pandemic are by zoom, and we have activities like karaoke, stretching workshop, and also inviting any performer, and this activities are so important because we can know better each other.

We want to offer a network between us to discuss opportunities, goals and serve as a platform to solve personal problems and concerns. Unfortunately, until now there is a lack of studies with real statistics of each Latin American country in relation to women and orthopedics, we are working to make our data more valuable.

Thus, we do not seek to separate ourselves, nor to be the same, we seek to have a space where we can grow personally and professionally with other tools to achieve the same goals without fear of harassment or bullying, having female references around the world and above all, having greater participation in academic activities worldwide.

Can we do it?  Of course, there is no limit and together we will achieve it!

Dr. Claudia Arias Calderón

Hospital Nacional Edgardo Rebagliati Martins

Lima- Perú

ISAKOS Launches Gender Diversity and Inclusion Task Force

Diversity is essential to create strong and productive organisations, maximizing the strengths and talents of all members of the society. Similarly, a diverse leadership group with unique experiences and perspectives is better able to generate novel ideas and goals, contribute different approaches to an issue, and provide a fresh viewpoint to an organisation.

Orthopedic surgery as a specialty clearly has a lot of work to do in expanding diversity within its ranks. ISAKOS, as an international specialty society, is well positioned to lead the way. While the ISAKOS Biennial Congress is a tapestry of racial, ethnic, and cultural diversity, there is one noticeable lack of diversity. Reflecting orthopaedic surgery as a whole, there are very few women. Just 5-7% of US orthopaedic surgeons are women and for many developing countries this percentage is even lower. ISAKOS currently reflects that reality.

The society membership statistics were reported in the latest edition of the ISAKOS Newsletter. There are currently 2,959 members of ISAKOS, of which just 106 (3.6%) are female. Unfortunately, in the history of ISAKOS, only two women have won named research awards at the ISAKOS Congress and just one has been awarded a Conference Scholarship. There are no women on the Executive Committee or Board of Directors of ISAKOS. Nor are there any female committee chairs. In fact, currently, female members fill just 14 of 250 (5.6%) ISAKOS committee positions. The Journal of ISAKOS Editorial Board fares a bit better, with 11.5% being women.

One area of well-earned pride for ISAKOS is its commitment to addressing geographic and cultural diversity. Achieving gender diversity and inclusion presents as the next challenge for societies such as ISAKOS as well as the entire orthopaedic community. Willem van der Merwe, MD and David Parker, MD, along with the Executive Committee of ISAKOS, aim to address this challenge. With full support from ISAKOS, the Gender Diversity and Inclusion Task Force has been established and consists of eighteen female members, from North America, South America, Europe, Asia and Asia-Pacific. Dr. Laurie Hiemstra is chair of the newly formed Task Force, with Drs. David Parker and Jason Koh serving as Executive liaisons.

Under the leadership of Dr. Hiemstra, the task force will guide ISAKOS in implementing and maintaining gender diversity and inclusion principles. Dr. Hiemstra is an orthopaedic surgeon specializing in sport medicine and arthroscopic surgery in Banff, Canada. She is an Executive Committee member of the Canadian Orthopaedic Association (COA) and the Arthroscopy Association of Canada (AAC). Dr. Hiemstra was recently elected 2nd President Elect of the COA and will be the first female president of the organisation.

The first goal of the ISAKOS Gender Diversity and Inclusion Task Force is to increase the number of female members and improve engagement by highlighting the lack of gender diversity within the society. Increasing the number of female members and clearly demonstrating inclusivity and acceptance within all areas of ISAKOS will help promote the society’s commitment to improving diversity.

The second goal is to increase female representation in educational activities, the biannual Congress, and executive structure of ISAKOS. The inclusion of a larger number of women in the ISAKOS scientific meetings and bi-annual Congress will create a wider range of ideas and viewpoints, and through this, improved teaching and learning for our members. As Julie Silver, MD, from Harvard University so eloquently says “For any award (or position or lecture or role) in medicine, there are more than zero women who deserve it.”

As with all initiatives, the Gender Diversity and Inclusion Task Force cannot succeed without genuine support from male allies. The vision of the #heforshe leaders in ISAKOS, Willem van der Merwe, Guillermo Arce, David Parker, Jason Koh, Volker Musahl, and Mark Clatworthy, is extremely important. Working together towards a stronger, more diverse ISAKOS should be the goal of all our members. We urge support, encouragement, and action for this important initiative.

Dr. Mary Mulcahey

Dr. Mary Mulcahey (@marykmulcaheymd) is a member of the Gender, Diversity and Inclusion Task Force for the International Society of Arthroscopy, Knee and Orthopaedic Sports Medicine (@ISAKOS_society). She earned her MD from the University of Rochester School of Medicine (@urmedical) in Rochester, NY, completed her orthopaedic residency at the Warren Alpert Medical School of Brown University (@brownorthopedics), and did her sports medicine fellowship at San Diego Arthroscopy and Sports Medicine. Dr. Mulcahey is an Associate Professor in the Department of Orthopaedic Surgery at Tulane University School of Medicine (@tulanemed) and the Director of Tulane Women’s Sports Medicine Program (@tuwomensportsmedicine). She is currently Secretary of the Ruth Jackson Orthopaedic Society (@ruthjacksonortho), which is a position in the Presidential line. Dr. Mulcahey is also very active in the Arthroscopy Association of North America (@aanaorg), American Orthopaedic Society for Sports Medicine (@aossm_1972), and the American Academy of Orthopaedic Surgeons (@aaos_1). She is passionate about improving diversity in orthopaedic surgery. Her areas of clinical expertise include shoulder injuries, rotator cuff tears, rotator cuff tendinitis, biceps tendinitis, shoulder instability, labral tears, knee injuries, ACL tears, meniscus tears, patellar instability, and tendon injuries.

Carola van Eck, MD, PhD

Dr. van Eck is an Editorial Board member for the Journal of the International Society of Arthroscopy, Knee and Orthopedic Sports Medicine (@J_ISAKOS). She earned her MD and PhD from the University of Amsterdam, the Netherlands, and went on to complete her orthopaedic surgical residency at the University of Pittsburgh Medical Center (@UPMC) and a fellowship in orthopaedic sports medicine at the Kerlan-Jobe Institute in Los Angeles. Dr. van Eck is an active member of several organizations including the Ruth Jackson Orthopaedic Society, Orthopaedic Research Society (@ORSsociety), European Society for Sports Traumatology, Knee Surgery and Arthroscopy (@ESSKA_society), Arthroscopy Association of North America (@AANAOrg), American Academy of Orthopaedic Surgeons (@AAOS1), Dutch Arthroscopy Society (@NedVerArthro), and the American Association of Hip and Knee Surgeons (@AAHKS). Dr. van Eck is in practice at the University of Pittsburgh Center for Sports Medicine, and serves as a team physician for Robert Morris University and the Pittsburgh Passion

Laurie Hiemstra, MD, PhD, FRCS(C)

Dr. Hiemstra is Chair of the Gender, Diversity and Inclusion Task Force for the International Society of Arthroscopy, Knee and Orthopedic Sports Medicine (@ISAKOS). She earned her MD from Memorial University of Newfoundland, completed orthopaedic surgical residency at University of Manitoba, Clinical Fellowship in Orthopedic Sport Medicine at the University of Western Ontario (@WesternU), and was the 2013-2014 recipient of the Patellofemoral Traveling Fellowship. She also has a PhD in Neuromuscular Physiology. Dr. Hiemstra is an Orthopaedic Surgeon at Banff Sport Medicine (@BanffSportMed) since 2005, and is the current appointed Director of Research. She is an Assoc. Professor at the University of Calgary (@UCalgary) and Vice President of the Arthroscopy Association of Canada (@ArthroscopyCA), as well as an active member of the Arthroscopy Association of North America (@AANAOrg), American Orthopedic Society of Sports Medicine (@AOSSM_SportsMed), and Canadian Orthopaedic Association (@CdnOrthoAssoc). Dr. Hiemstra is committed to increasing inclusion and leadership roles for women and under-represented minorities in Orthopaedics, and is also a member of the International Orthopaedic Diversity Alliance (@orthodiversity).

Elizabeth Arendt, MD

Dr. Arendt is an active member of the International Society of Arthroscopy, Knee and Orthopedic Sports Medicine (@ISAKOS) and serves on the Journal of ISAKOS Editorial Board (@J_ISAKOS). She earned her MD from the University of Rochester (@UR_Med), completed orthopaedic surgical residency at Strong Memorial Hospital, and completed sports medicine residency and fellowship at the University of Minnesota (@UMNOrthoSurg). She is a Professor and Vice-Chair in the Department of Orthopaedic Surgery at University of Minnesota Medical School (@UMNMedSchool), and is also on the Editorial Boards of several other publications including the British Journal of Sports Medicine (@BJSM_BMJ), Orthopaedics Today, Sports Medicine and Arthoscopy Review, and the American Journal of Sports Medicine (@AJSM_SportsMed). Dr. Arendt is the Medical Director for the University of Minnesota’s Inpatient Orthopaedic Ward (2007-Present) and Assoc. Medical Director of Women’s Sports Medicine at TRIA Orthopaedic Center in Woodbury, MN. She has received numerous recognitions including “Top Doctor” from Mpls St. Paul (2008, 2012-2019) and “Best Doctor” from Minnesota Monthly (2014-2017).

Dr. Ashley Bassett

Dr. Ashley Bassett is a fellowship-trained orthopedic surgeon specializing in the treatment of sport-related injuries in athletes of all ages. She received her medical degree from Rutgers Robert Wood Johnson Medical School where she was elected into the Alpha Omega Alpha Honor Society and Gold Humanism Honor Society. Dr. Bassett then completed her surgical residency at the Harvard Combined Orthopedic Residency Program. After residency, Dr. Bassett went on to earn a fellowship specializing in sports medicine at the Rothman Orthopaedic Institute at Thomas Jefferson University in Philadelphia, where she was a team physician for the Philadelphia Eagles, Phillies, Flyers and 76ers, as well as Villanova University and St. Joseph’s University Athletics. During her fellowship, she was presented the Philip Syng Physic Award for research on return to play testing after ACL reconstruction. Dr. Bassett is now the Director of the Women’s Sports Medicine Center at the Orthopedic Institute of New Jersey, the only highly-specialized center for the care of female athletes in northern New Jersey. In her free time, Dr. Bassett enjoys being outdoors, hiking and playing the occasional squash match with her husband.


It may seem odd that the first ISAKOS Blog post is from an epidemiologist and about an infectious disease, but that is the state of the world today.

I have been somewhat slow in composing this post during the coronavirus pandemic largely because early on there is still so much we do not know about the disease. That’s still true, but I now believe it’s past time to get this information out.

While ISAKOS is a medical/surgical society, in my interactions on twitter (@orthoepi for those who would be so kind as to follow me) I have been struck by how many orthopedic surgeons are grateful for information about how to adjust to life in the age of coronavirus. As such, if you find this blog post useful, please share it far and wide with friends, family, and colleagues. There is so much we can do to reduce the effects of this pandemic and get back to what can only be described at this point as the new normal, which I hope we can address in a future post.

For background, I have been a clinical epidemiologist at the Hospital for Special Surgery in NY for nearly 18 years focusing primarily on sports medicine and arthroplasty outcomes. While I have never studied epidemic disease professionally, I am well versed in the technical terms and understand how epidemics ebb and flow.

First off, let’s set the stage with an overview of some highlights. 

NOVEL CORONAVIRUS: This virus is deadly serious – for now. We have no immunity to it and it’s killing at a higher rate than the flu. There is no vaccine. There is no proven cure. The best thing to do is not get infected and if you do get infected, do your best not infect others. The good news is that as this virus mutates it may become less dangerous (over 18-24 months) and as more and more people are infected, it will not spread as easily. We will get past this. It is not the apocalypse.

SPREAD: The virus is most often spread through close contact with an infected person. This is primarily being spread through families, close friends, or coworkers. But it can also easily spread during events were big groups of people get together such as festivals, sporting events, night clubs, or bars and restaurants. It appears most commonly spread through the air if you’re close to an infected person, though it is also spread through shaking hands with an infected person or touching a contaminated surface. Healthcare workers who have lasting sustained contact with infected patients without adequate personal protective equipment are certainly at risk. One of my first friends to become infected is a private practice allergist who had a number of his regular patients seeking help in his clinic. He had no idea what he was up against.

RISK: Everyone is at risk of COVID19 and serious complications. Children appear to have more mild disease, but some still have extremely serious symptoms. It mainly appears to effect people with other comorbidities. Obesity is a risk factor. Males are at higher risk than females. Older people are at higher risk of hospitalization and death, although even people in their 20s and 30s can end up in intensive care units and some have even died. It appears to be causing heart attacks,  strokes, and thromboembolic events in younger people with no other risk factors

PREVENTION: Simple measures like social distancing and sanitation are most effective. I recommend reading the latest JISAKOS editorial by Niek van Dijk on COVID19 which provides an excellent historic perspective on hand washing policy. . Stay away from people who could be sick (which during an epidemic is almost everyone) and wash your hands anytime you touch something that you don’t know where it’s been (which is most of the things we touch outside our homes). Alcohol solutions above 62% and diluted bleach are also effective for killing the virus on surfaces. And it goes beyond saying that you should not drink bleach and alcohols produced for sanitization.

INFECTION: How do you know you’re infected? In some cases you don’t. Some people never develop any symptoms. Early in the disease you may have a fever, fatigue, diarrhea, dry cough, sore throat or some combination. Many lose their ability to smell or taste, which seems to be a telltale sign that it’s not a regular flu. Up to 90% of patients have a fever. Most people should start to feel better in 5-7 days after first developing symptoms, though some will crash again and develop shortness of breath or other serious complications. If the shortness of breath becomes unmanageable, this is the point where you should seek medical attention. Otherwise, you should be able to self-manage and let the healthcare system take care of those who are in worse condition.

RECOVERY: Once you’re feeling better, get back to work. However, understand that you may still carry the virus for as many as 2 weeks so follow those precautions so that you don’t infect others. 95% of people who have been infected will be virus free within one week after they recover, but if you are part of that 5% who still carry the virus, it is better to be cautious (remember, 5% is 1 in 20 – not a rare situation at all). Also, volunteer to help others. Donate blood if a hospital in your community is testing antibody therapies. The world needs you.

That’s it. Feel free to stop reading here if you think you’ve got this.

Please stay safe and healthy. We are stronger together (at a safe distance).

Now …

If you’d like more specific recommendations, by all means, please keep reading.


For more specifics on this, I’ve put together the following “tips” for those who may be confused by all of the information you may be hearing or reading. This information comes from medical professionals, my reading of research coming out of infected areas, and my understanding of how infectious diseases spread.


I would say this to those who live in areas that are not yet affected or have relatively few cases identified.

COVID19 IS ALREADY IN YOUR COMMUNITY. This is not to alarm you, but to let you know that the number of undiagnosed cases in communities without widespread testing may be as high as 100x as what is being reported. If your town has 5 confirmed cases, you can assume that number is possibly closer to 500. This holds true until widespread testing begins. The area where I live most of the year, Fukuoka, Japan, had 656 reported cases as of May 14th. While I do not think there are 65,600 cases here due to Japanese cultural norms, I would not at all be surprised to learn there are 6,000 to 12,000 cases, because there simply isn’t enough testing being done.  Health authorities in many countries report that only 1-7 % (average 3%) of their population has currently been infected. For herd immunity, the point at which most people exposed to the virus are not at risk of getting sick, we need approximately 60% of the population infected or vaccinated according to  WHO guidelines.

SOCIALLY DISTANCE. Coronavirus is primarily spread through contact with an infected person. The easiest way to social distance is to assume you are infectious and keep at least 1 to 2 meters away from anyone else as much as possible. Work from home if your job allows it. Don’t see friends or family any more than necessary. If you choose to continue to socialize, keep your social circle small and avoid crowded places. Use video chat or the telephone to keep up with those important to you.

DEVELOP GOOD SANITARY HABITS. Before the virus is widespread in your community is the time to start new, better habits around keeping clean. Don’t touch your face. Many of us touch our face hundreds of times a day without realizing it. Start realizing it. Wash your hands like a Take your shoes off at the front door (or in the garage if you have one). Change your clothes as soon as you get home. Don’t re-wear clothes you’ve worn outside. Avoid touching more surfaces than necessary when in public. These habits may seem like overkill now, but they’re easier to adapt when you’re not in the center of a crisis than when you are.

BUILD UP YOUR IMMUNE SYSTEM. Get enough sleep. Don’t drink too much alcohol. Don’t smoke or vape. Eat fresh, nutrient rich foods. Stress is hard on the immune system and as we face this disease, all kinds of stress is likely to occur. So it’s vital that we all get some downtime – read a book, watch a movie, enjoy a hobby. This applies triply if you develop COVID19. Do your best to stay hydrated, fed, and well rested. Your immune system will need the energy.

DON’T PANIC SHOP. Buy what you need, but don’t hoard necessities that others need as well. In case you get stuck indoors during the peak of the epidemic and you need to stock up food, then choose foods that can be stored for weeks or months like pasta, rice, beans, canned vegetables, canned fish, etc. Try to limit grocery shopping to no more than once or twice a week.

WEAR A MASK IN CROWDED PUBLIC PLACES. If you are sick it lessens your chance of spreading the virus. It also prevents you from so easily inhaling someone else’s cough or sneeze droplets, which is more likely in a crowd. Also, please note that “do not touch your face” also applies to “do not touch your mask” – if the mask has kept virus from contacting with your nose or mouth the virus may still be on your mask so touching it may contaminate your hands. Some masks can be reused if gently washed with soap and warm water. You don’t need to treat them as disposable.

Note: if you’re in a high risk area it may be best to dispose of them after a single use, but since we don’t know just how long this is going to last, even a good supply of masks may dwindle quickly. I’m currently switching back and forth between 2 masks which I wash and hang to dry as soon as I return home.


ASSUME EVERYONE YOU MEET IS INFECTED. Do not take anyone’s seeming lack of symptoms to be a sign of safety. Just because you know someone personally doesn’t mean they don’t carry the virus. Many cases of infection appear to have been from someone who was infected, but 1-2 days before they showed symptoms, so most people are infectious before they know it.

ASSUME EVERY PUBLIC SURFACE IS INFECTED. The virus can survive in indoor air for about 3 hours (ventilation may clear it away more quickly) and on hard surfaces for up to 3 days. Wear rubber gloves when you are going someplace where you may need to touch public surfaces. If using disposable rubber gloves, dispose of them upon returning home. Use recommended medical glove removal technique (check YouTube).

DELIVERIES. In this environment, it’s better to order delivery and be exposed to one person than to venture out and be exposed to many. However, this is not good for the delivery person (other than the paycheck). If you order delivery, ask the delivery person to leave the packages at the door. Tip them well if tipping is customary in your community. They’re risking their health and life to get supplies to you. If you go out for shopping instead, stay 1-2 meters from anyone, wear a mask, and wear rubber gloves.

UNPACKING DELIVERED OR PURCHASED ITEMS. Keep in mind that the delivery person is probably not the only person who has handled the items you had delivered (or the items you picked up on the store shelves). Unpack them outdoors or in your entryway. Once you’ve opened the outer package (preferably with gloves), sanitize your hands before removing the interior items. Dispose of the outer packaging immediately.

ITEMS YOU BRING INTO YOUR HOME. Wash any items you can with soap and water. Things that can’t be washed should either be wiped down with alcohol or left in an unused part of your living space for 3-4 days.  After finishing this cleaning process, wash your hands thoroughly.


Despite taking precautions, some of us may still develop COVID19. Here’s what to do if you get sick.

STAY HOME and in a separate room than those you live with who are not yet sick. You being sick does not guarantee they will catch it so be careful for their sake. If someone in your home has already recovered from the virus, they’ll need to be the one who takes care of you. They’ll need to be doubly careful not to infect others who have not yet gotten sick by following the precautions above. If someone lives with you, clean up everything you touch in shared spaces with soap and water or alcohol.

DON’T SEEK MEDICAL ATTENTION unless your symptoms become serious. Emergency departments are being overwhelmed with too many people seeking care. Most “mild” cases start to recover in about 5 days after onset of the symptoms, so hold out at least that long if you can. I wrote “mild” because apparently even mild cases are often miserable with fever, sore throat, cough, body aches, and tiredness. Shortness of breath is a common symptom with more serious cases of COVID19, but even some of them can be self-managed. Lying on your stomach can help relieve this symptom and emergency room physicians have even avoided putting people on a respirator by having them lie on their stomach.

IF YOUR SYMPTOMS GET WORSE. If your symptoms worsen or do not start to get better within about 7 days, call your physician (or a helpline that’s probably been set up in your community). They will instruct you what to do. It is at about this time that a diagnostic test may be necessary since you may need medical attention to recover. They should also let you know which warning signs represent an emergency for which you should go to the hospital. Some physicians are suggesting that if you develop shortness of breath, that’s when you should go to the hospital.


Many of us may end up caring for loved ones who get sick. Just because they’ve gotten sick doesn’t mean you will. If you follow the above suggestions and those below, you have the best chance of avoiding infection.

SEPARATE LIVING AREAS & BATHROOMS. Ideally the sick person should have their own bedroom and bathroom. If there is only one bedroom, the sick person should be isolated there and others should sleep in the main living area. If there is only one bathroom it will need to be thoroughly cleaned every time the sick person uses it. Soap and water or alcohol will do the trick. If they’re too fatigued to do it, someone else will have to do it for them.

TAG TEAM IF YOU CAN. If more than one healthy person lives in the house, you should work together – one to collect and clean possibly contaminated clothing, dishes, etc. and the other to open and close doors, get soap, etc. If there is only one other person in the house, you should be extra careful in sanitizing anything you touch after cleaning up for your sick family member.

AVOID HIGH RISK FAMILY MEMBERS. If an elder or someone with other medical problems lives in the same home, their caregiver should not also care for the person with COVID19. If there is only one caregiver available, the high risk family member should be isolated or moved to another residence if possible.


CONSIDER DONATING PLASMA. A number of hospitals around the world are testing the ability of the antibodies in survivors’ blood to help those currently sick with the virus to fight it off more effectively. This could save lives.

GET BACK TO WORK. Society is going to need the economy to keep moving forward. Goods and services will still need to be made and delivered. Those who recover are an invaluable part of that. However, understand that you may still be carrying the virus so keep using those precautions to make sure you don’t get others sick.

CONSIDER VOLUNTEERING. There are so many things that need to be done and in many cases those who would be doing them are either at risk of getting sick or are too sick to do them. Find what help is needed in your local community, and volunteer to help.


COVID19 is a legitimate pandemic and a threat to our health and welfare. However, it is not an invincible disease. It’s just a virus just like any other and can be killed very easily with soap and water or high alcohol solutions. We just need to get into good habits of social distancing and sanitation. With just those two main things, we can beat this together to prevent further illness and death.

Please stay safe and healthy. We are stronger together (at a safe distance).

-Stephen L. Lyman, PhD JAPAN, Communications Committee Chair