Frontiers of Orthopaedic Surgery

This episode examines what it actually takes for athletes to return to their prior level of performance after knee injury. Host Dr. Joaquin Moya-Angeler is joined by Professor Romain Seil and Francesco Della Villa for a discussion spanning rehabilitation, joint preservation and how the goals of sports medicine have shifted over time.

A central theme is the distinction between returning to sport and returning to performance – many athletes rejoin their teams, but regaining their pre-injury level of play is a separate and often harder benchmark.

The conversation also addresses long-term joint preservation, particularly in younger athletes. Professor Seil notes that a knee injury can accelerate joint ageing, and argues that athletes and their families should understand these long-term risks as part of return-to-sport decisions. The discussion extends to the ethical dimensions of returning young athletes to competition, and the case for more informed, shared decision-making.

Seil and Della Villa outline criteria they consider relevant to guiding return-to-competition decisions, noting that psychological readiness develops alongside physical recovery rather than following it.

They also discuss how wearable technology and data analytics are being used in rehabilitation settings, potentially supporting more individualised protocols based on an athlete's recovery data.

The episode closes on the value of a multidisciplinary approach – orthopaedic surgeons, physiotherapists and sports medicine specialists working together toward recovery plans that address both performance and long-term joint health.

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What if knee replacement surgery started with the knee in front of you, not a textbook standard? That's the premise behind functional knee phenotyping, the topic of this episode with host Joaquin Moya-Angeler and guests Michael Hirschmann and Sebastien Lustig.

Rather than applying rigid mechanical alignment rules across the board, this approach asks surgeons to read each patient's unique anatomy and soft tissue behaviour – and to plan surgery around it. Hirschmann and Lustig walk through what that looks like in practice, from balancing soft tissue dynamics to using 3D imaging and robotic navigation to understand how a knee actually moves.

It's a shift that's still finding its footing in clinical practice – the guests are honest about the learning curve – but the potential upside for patient outcomes and satisfaction has both experts optimistic about where the field is headed.

Tune in for a grounded, expert look at one of the more significant shifts happening in TKA today.

Papers, books and resources discussed:

More about Stephen Howell: https://www.drstevehowell.com/for-physicians/ 

Leal-Blanquet, J., Haddad, F., Lustig, S., Bonnin, M., Van Hellemondt, G., Rivière, C., Pujol, O. and Hirschmann, M.T. (2026), Restoring the native knee or designing the ‘optimal prosthetic’: Alignment, phenotypes and AI-powered personalization in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc., 34: 800-803. https://doi.org/10.1002/ksa.70147

Andriollo L, Koutserimpas C, Gregori P, Vermue H, Hirschmann MT, Lustig S. Dynamic Alignment of the Knee (DyAK) Classification: Advancing Knee Evaluation in Robotic Arthroplasty. J Arthroplasty. 2026 Jul;41(7S1):S147-S154. doi: 10.1016/j.arth.2026.03.008. Epub 2026 Apr 1. PMID: 41945034: https://pubmed.ncbi.nlm.nih.gov/41945034/

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Host Joaquin Moya-Angeler sits down with Elizaveta Kon and Laura de Girolamo to unpack the fast-growing field of orthobiologics – biologic therapies, including platelet-rich plasma (PRP), used to treat joint and musculoskeletal conditions.

The conversation opens with a quickfire round of ten questions, giving both guests a chance to weigh in on where the field currently stands. One theme comes through clearly: PRP preparation and outcomes still vary significantly from case to case, which makes understanding the underlying pathology essential before recommending treatment.

From there, the discussion turns to why orthobiologics have grown so quickly – a mix of genuine clinical need, biological appeal, and market pressure. Osteoarthritis patients, who often have few good treatment options, are a major driver of this demand. But Kon and de Girolamo are careful to flag the downside of that rapid growth: neither the evidence base nor the regulatory frameworks have kept pace, leaving clinicians and patients alike navigating a fair amount of confusion.

Managing expectations is where the episode spends real time. Biologics can meaningfully improve symptoms and quality of life, but they're not a cure – and both guests stress that clinicians need to communicate that clearly and honestly with patients from the outset.

Looking ahead, the conversation covers where the field is heading next: the potential of gene therapy, the push for standardisation in how products are prepared, and ongoing research into personalised protocols that account for each patient's specific condition.

Kon closes with practical advice for practitioners – stay focused on the individual patient in front of you, and choose biologic products backed by solid evidence.

Papers, books and resources discussed:

More on ESSKA Orthobiologics Initiative: https://www.esska.org/news/593282/ESSKA-Orthobiologic-Initiative-ORBIT-Consensus-Process-on-Blood-Derived-Products-.htm

Optimizing Clinical Use of Biologics in Orthopaedic Surgery: Consensus Recommendations From the 2018 AAOS/NIH U-13 Conference: https://www.researchgate.net/publication/328167386_Optimizing_Clinical_Use_of_Biologics_in_Orthopaedic_Surgery_Consensus_Recommendations_From_the_2018_AAOSNIH_U-13_Conference

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In this episode, we explore the advancements in ACL reconstruction with orthopaedic experts Andy Williams and Antonio Klasan. Join host Joaquin Moya-Angeler as they discuss the seven key elements for successful ACL surgery, the importance of individualised graft selection, and the role of innovative technologies in improving patient outcomes. Discover how understanding associated injuries and rehabilitation can lead to better recovery rates and what the future holds for sports surgery.

Key themes:

• What is needed for a successful ACL surgery
• Individualised graft selection
• Innovations in technology, including 3D planning, robotics and AI
• Return to sport criteria and the importance of a thorough assessment to ensure readiness

Papers, books and resources discussed:

Slocum DB, Larson RL. Rotatory instability of the knee. Its pathogenesis and a clinical test to demonstrate its presence. J Bone Joint Surg Am. 1968 Mar;50(2):211-25. PMID: 5642814. https://pubmed.ncbi.nlm.nih.gov/5642814/

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In this episode, we explore the evolving landscape of knee osteotomies with esteemed orthopaedic surgeons Dr. Matthieu Ollivier and Dr. Kristian Kley.

Key themes:

• Historical significance of knee osteotomies
• Misconceptions surrounding them
• Technical aspects of performing osteotomies (e.g. 3D planning software and patient-specific instrumentation)
• Importance of preserving this technique

Papers, books and resources discussed:

"Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals." Micicoi G, Jacquet C, Khakha R, LiArno S, Faizan A, Seil R, Kocaoglu B, Cerciello S, Martz P, Ollivier M.
Am J Sports Med. 2021 Dec;49(14):3816-3824. doi: 10.1177/03635465211050421. Epub 2021 Oct 28. PMID: 34710345 Free article. https://pubmed.ncbi.nlm.nih.gov/34710345/

"The Effect of Lateral Extra-articular Tenodesis on Anterior Cruciate Ligament Graft Forces and Knee Stability Compared With Slope Reduction Osteotomy in the Setting of Increased Posterior Tibial Slope." Lemme NJ, Badida R, Molino J, Quinn M, Hague M, Fleming BC, Owens BD. Am J Sports Med. 2025 Jul;53(8):1912-1920. doi: 10.1177/03635465251338236. Epub 2025 May 21. PMID: 40396207  https://pubmed.ncbi.nlm.nih.gov/40396207/

"Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament–reconstructed patient." Webb JM, Salmon LJ, Leclerc E, Pinczewski LA, Roe JP. American Journal of Sports Medicine. 2013;41(12):2800–2804. doi:10.1177/0363546513503288 https://pubmed.ncbi.nlm.nih.gov/24036571/

“Considerations of the Posterior Tibial Slope in Anterior Cruciate Ligament Reconstruction” Nazzal EM, Musahl V, Getgood A, et al. Journal of ISAKOS, 2022 https://pubmed.ncbi.nlm.nih.gov/35653051/

ESSKA European Certification Programme (with Osteotomies Around the Knee Module): https://esskaeducation.org/european-certification?utm_source=esska_educ_certif

"Principles of Deformity Correction" by Dror Paley: https://link.springer.com/book/10.1007/978-3-642-59373-4

"Osteotomy : with an inquiry into the ætiology and pathology of knock-knee, bow-leg, and other osseus deformities of the lower limbs" by William MacEwen: https://wellcomecollection.org/works/dtmhbeus

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In the pilot episode of Frontiers in Orthopaedic Surgery, host Joaquin Moya-Angeler sits down with Professor Michael Hirschmann – editor-in-chief of KSSTA Journal – to explore the trends, technologies, and philosophies shaping the future of orthopaedic surgery.

Key takeaways:

• Mentorship is essential for emerging professionals in orthopaedics
• Personalized medicine – not mean value thinking – is the future of orthopaedic research
• AI and robotics enhance surgical capability, but cannot replace the human touch
• Transparency in AI use is critical for maintaining research integrity
• Sports medicine is evolving toward prevention-first, individualized care

Stay curious, stay collaborative – as Professor Hirschmann reminds us, every contribution matters in the scientific community.

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