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aveling Fellowship_Ruby Scrum.gif
Fig. 1 A rugby scrum


Published 7/1/2011
Maureen Leahy

Fellowship recipients sharpen skills abroad

Five-city tour focuses on care and treatment of athletes

Last November, Kevin M. Doulens, MD, and Lutul D. Farrow, MD, completed the 2010 European Federation of Sport Traumatology (EFOST) Travelling Fellowship, sponsored by EFOST and DonJoy Orthopedics. The fellowship facilitates the exchange of information and ideas between U.S. and European sports-medicine physicians on a wide variety of topics ranging from athletic care, rehabilitation, and injury prevention to new directions in orthopaedic research.

During their 16-day trip, Drs. Doulens and Farrow visited with sports-medicine professionals, researchers, and athletes in Tel Aviv, Israel; Barcelona, Spain; London; Paris; and Brussels, Belgium. The visiting surgeons quickly discovered that, despite the thousands of miles separating them, when it comes to the care and treatment of athletes, U.S. sports-medicine physicians and their international colleagues are more alike than they are different.

“Although some of the sports are different, we pretty much deal with the same type of injuries,” said Dr. Doulens. “The difference is that most European professional sports team doctors are primary care physicians rather than orthopaedic surgeons—the orthopaedic surgeon acts more as a consultant. We each have our own treatment approaches, but overall we are more similar than we are different.”

“I had assumed that the surgical instrumentation and techniques used would be very different from what we are accustomed to in the states,” added Dr. Farrow. “It turns out that we use a lot of the same instruments and have very similar surgical techniques.”

In addition to surgical care, the fellowship also focused on the care of athletes in the training room and on the sidelines. In most of the cities, the visiting surgeons were able to spend time in the clinic, in surgery, in the athletes’ training rooms, and on the sidelines at athletic events.

In Tel Aviv, Drs. Doulens and Farrow toured the facilities at Meir Medical Center, where cutting-edge research on sports injury treatment and rehabilitation is being performed, attended a radiology conference where they provided their opinions on diagnosis and treatment for patients, and observed several shoulder and knee surgeries.

“Based on the surgeries I observed in Tel Aviv, I have modified my technique for anterior cruciate ligament reconstructions. I now use a medial portal technique to create the femoral tunnel,” said Dr. Doulens. “I had been thinking about doing it, and after watching the Israeli surgeons, I now use the technique all the time.”

Soccer, science, and PRP
The fellowship also introduced the visiting surgeons to sports that are lesser known in the United States. In Barcelona, they met with the medical director for Futbol Club Barcelona, Spain’s professional football (soccer) club, and visited the club’s training facilities and stadium.

“Soccer in Europe is a whole different culture than what we are used to in the states. Being able to see the set-up they have in Barcelona for taking care of soccer athletes was a phenomenal experience,” said Dr. Farrow.

“We also talked with the club’s physicians, trainers, and physical therapists about treatment options, including platelet-rich plasma (PRP). PRP is very popular in Spain—and in Israel,” said Dr. Doulens. “We visited a PRP clinic at Quiron Hospital run by Ramon B. Cugat, MD, and his wife, who is also a doctor. The clinic administers PRP injections to hundreds of people weekly. PRP is used everywhere—it is injected into shoulders, knees, and hips. The plastic surgery arm of the clinic even uses it for cosmetic purposes.”

In London, the visiting surgeons spent a great deal of time in the clinic with clinician scientist Prof. Nicola Maffuli. They also participated in a scientific conference with Prof. Maffuli and listened as PhD candidates presented their research; afterward Drs. Doulens and Farrow provided input on the students’ research projects.

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Fig. 1 A rugby scrum
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Fig. 2 (left to right) Lutul D. Farrow, MD; Dr. M. Nedim Doral, EFOST treasurer; Prof. Nicola Maffulli; Kevin M. Doulens, MD; and Dr. Lior Laver at the EFOST meeting in Brussels.

“Prof. Maffuli has a team of physicians, fellows, residents, and others all working on multiple projects simultaneously,” marveled Dr. Doulens. “We were very impressed with how people from diverse disciplines, including cellular microbiology and exercise physiology, can work together, and how their efforts tie in to sports medicine.”

A highlight of the surgeons’ visit to Paris was the tour of the French national sports team facilities.

“The soccer and rugby facilities are spectacular—they have multiple indoor and outdoor fields and every type of weight-lifting and physical therapy machine that you can imagine,” said Dr. Doulens. “They also have a scrum simulator—reportedly the only machine of its kind in the world—for the rugby team that allows the players to optimize their scrum technique to avoid injury (Fig. 1).”

While there, Drs. Doulens and Farrow were asked to evaluate and provide input on treatment for a rugby athlete with a chronic tear of the ligaments in the knee. “The team physician, who is an orthopaedic surgeon, was leaning toward surgery for this patient. After evaluating the patient, I was able to share my reasons for recommending nonsurgical management,” said Dr. Farrow.

Soccer and rugby are played nearly year round in Europe and athletes may not have adequate time to recover from their injuries. “Because their recovery times are short, European athletes have problems with tendonitis and tendinopathy. We learned a great deal about the treatment of those conditions, which I will likely incorporate into my practice,” said Dr. Farrow.

Dr. Doulens and Farrow ended their trip at the EFOST annual meeting in Brussels (Fig. 2). At the conference, they attended lectures given by sports-medicine experts from all over the world. Afterward, they enjoyed watching a soccer match from the private section of the stadium for Football Club Brussels.

Incredible memories
The surgeons experienced the local culture in each of the cities they visited, and when time allowed, they also did some sightseeing.

“The educational aspect aside, the 3-hour tour of Jerusalem led by one of our local hosts, Gideon Mann, MD, was the highlight of my time in Israel,” said Dr. Farrow.

“We really enjoyed meeting different people and seeing different cultures,” added Dr. Doulens. “Barcelona is one of the most beautiful cities I have ever seen—the architecture is just spectacular and the people are so nice,” said Dr. Doulens. “To be able to enjoy the beauty and history of these cities while learning at the same time was just incredible.”

“I will be forever grateful for this experience,” added Dr. Farrow. “All of our hosts were wonderful—we met a lot of very important people within the European orthopaedic community with whom we now have lasting relationships.”

Dr. Doulens is in private group practice in Fleming Island, Fla. He is the team physician for Fleming Island High School and medical director of the Jacksonville Marathon. Dr. Farrow is associate staff at the Cleveland Clinic Sports Heath Center in the Cleveland Clinic Orthopaedic and Rheumatologic Institute, and an assistant team physician with the Cleveland Browns.

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org