To

Dr. Pushpinder Bajaj
ISKSAA Founder
Centre of sports injury
New-Delhi
01^st May, 2025

Subject: Fellowship Review – ISKSAA Travelling Fellowship, April 2025

I am truly honoured to have been selected for the prestigious ISKSAA Travelling Fellowship from April 1^st to April 30^th, 2025, held at the Missouri Orthopaedic Institute, Columbia, Missouri, under the mentorship of some of the most esteemed orthopaedic surgeons in the world. This experience has not only expanded my clinical and surgical acumen but also profoundly impacted my professional approach and commitment to orthopaedic excellence.

The cornerstone of my learning during this fellowship was my time spent under Dr. Ajay Aggarwal, an exceptional surgeon and mentor. Dr. Aggarwal’s deep understanding of both hip and knee arthroplasty and arthroscopy was evident in every case he performed. His surgical finesse, especially during complex revision hip arthroplasties, was truly remarkable. What impressed me most was his efficiency and precision — delivering consistently successful outcomes with swift surgical timing while maintaining the highest standards of safety and accuracy.

I had the privilege to scrub in and observe all of Dr. Aggarwal’s cases from close quarters, which gave me direct insight into the nuances of implant positioning, soft tissue balancing, and intraoperative decision-making. He welcomed every question with immense patience, explaining each concept with clarity, often using imaging or intraoperative visuals to enhance understanding. Beyond his surgical brilliance, his warmth and humility stood out — he made me feel like part of his family, which made each day not just educational but emotionally fulfilling as well. In addition we observed his finesse in hip arthroscopy, Hip preservation surgeries which included Labral repair for FAIs. He also made sure we were supplied with adequate books, DVDs, literature for us to understand the theory better.

Another highlight was observing Dr. Elie Ghanem, a highly skilled hip surgeon renowned for his proficiency in anterior approach total hip arthroplasty. His calm, structured operative style and ability to perform these technically demanding procedures with apparent ease left a lasting impression. On 30^th April, he conducted a cadaveric lab focused on anterior hip replacement, which served as an eye-opener. The practical exposure, combined with his detailed anatomic and technical commentary, demystified many of the challenges I had associated with this approach. His methodical teaching bridged textbook knowledge with hands-on reality.

I also had the fortune to learn from Dr. Matthew Smith, a doyen in shoulder arthroplasty, whose work in both primary and complex revision cases is internationally respected. Under his guidance, I observed primary total shoulder arthroplasty, reverse shoulder arthroplasty, and challenging revision procedures like conversion of anatomical total shoulders to reverse configurations. What stood out was his use of an implant system he helped design with Depuy Synthes, offering a level of personalization and insight that is rarely seen. His ability to restore function and biomechanics in difficult shoulders was deeply instructive, and he brought an admirable clarity to teaching complex decision-making during surgery.

In the field of arthroscopy, in addition to above surgeons we saw cases under Dr. Clayton Nuelle, Dr. Defroda who were expert in sports injury management. I was exposed to a wide variety of procedures across the knee, shoulder, and hip. The spectrum included ACL, PCL, and PLC reconstructions, meniscal repairs and allograft transplants, Bankart repairs, and rotator cuff repairs with patch augmentation etc. I am equally grateful for Dr. Nuelle and Dr. Defroda

I had extensive hands-on experience in cadaveric labs. On 14^th April, the Missouri Orthopaedic Institute Bio-skills Lab hosted a detailed hip arthroscopy cadaveric workshop, which greatly strengthened my understanding of intra-articular hip anatomy and labral work. On 18^th April, at the St. Louis Stryker Lab, I participated in a hip and knee arthroplasty cadaveric session using the MAKO 4.0 robotic system. This session was instrumental in helping me connect robotic theory with real-world surgical movements and planning. Both workshops were meticulously conducted and gave me the chance to practice in a controlled environment, helping cement my concepts in robotic-assisted arthroplasty.

Beyond the operating room, I also joined Dr. Ajay Aggarwal in his outpatient clinics twice a week. These sessions offered me a real-world look into clinical evaluation, imaging interpretation, and surgical planning, further enriching my understanding of patient-centered orthopaedic care.

The environment at Missouri Orthopaedic Institute was welcoming and energizing. The faculty, fellows, and supporting staff maintained a healthy academic culture where learning thrived through daily interaction and collaboration. I felt encouraged, supported, and constantly motivated to ask, learn, and grow.

I extend my deepest gratitude to ISKSAA, particularly Dr. Pushpinder Bajaj, Dr. Ajay Aggarwal, and Dr. Lalit Maini, for facilitating such a transformative experience. I return to India with enhanced confidence, broadened perspectives, and newly acquired skills that I am eager to integrate into my practice. I sincerely recommend this fellowship to every young orthopaedic surgeon looking to shape their future through world-class mentorship and exposure.

Warm regards,