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In Memoriam: Jan Gillquist, M.D., Ph.D.

      “There is no substitute for thinking” was one of the sentences I heard from Jan Gillquist when I worked for some months in his department in Linköping and learned arthroscopy and a lot more back in 1983. At that time, I was just a beginner in the third year of my training as an orthopaedic surgeon. Jan Gillquist surrounded himself by an atmosphere of strict scientific thinking. Ideas were encouraged, but acceptance was dependent on test results. Promises were held. Many young surgeons received his support. The scientific reputation of his team was legendary.
      On May 12, 2016, Jan Gillquist died at age 82. I am one of the surgeons who will forever be grateful for his teaching and his support, which has tremendously helped me and others to tap into our own surgical and scientific potential.
      Jan Gillquist was born in Motala, Sweden, in 1934. After school, his own wish was to become a journalist. Thanks to his critical mind, sense of humor, and exceptional drawing skills, he was especially drawn to human and political satire and caricature. However, his father decided that the medical profession would give him a better future, and Jan obeyed. Jan studied medicine at Karolinska Hospital (1953-1959), became a general surgeon at Danderyd Hospital (1960-1965), and finished his thesis (1969) about biochemistry of bleeding shock at Karolinska Institute, with excellence. Nevertheless, Jan's first lecture as an associate professor, 1 year later, was about sports injuries. In 1971 he followed his tutor-professor Sten-Otto Liljedahl to Linköping University. In Linköping, inspired by a little book from Watanabe, Jan Gillquist began performing arthroscopy using the first arthroscope from the Stille company. And that was when Linköping University Hospital started to become one of the world's finest centers for arthroscopy, knee surgery, and orthopaedic science, because one of the clearest brains and best researchers and teachers in orthopaedic surgery had devoted his energy to this field of medicine.
      During the early decades of arthroscopy, the lack of standardization and the discrepancy between arthroscopic schools made things rather complicated and hindered quick success. It was an enormous merit of the Gillquist school to develop a straightforward technique of arthroscopy based on a solid scientific background. The “Swedish technique” was easy to learn and to use. Despite being one of the pioneers of arthroscopy with considerable personal operative experience, Jan Gillquist did not rely on his opinion or his impression but put everything on scientific testing: “In church you may believe, in medicine you have to know.” Together with G. Hagberg, the central approach to knee arthroscopy was established. The aim was to minimize the blind areas within the joint and to define the best single portal for the arthroscope. Jan Gillquist and his coworkers acquired an international reputation starting with the support of Watanabe from Japan, who made Jan a member of the International Arthroscopy Association. Jan became president of the International Arthroscopy Association in 1989. In the early eighties operative knee arthroscopy was already routine in Linköping. Improved operating instruments and the triangulation technique—invented and popularized by Jan Gillquist—allowed for a leap forward in arthroscopic meniscal surgery. N. Oretorp was his strong support during these years of technical improvements. But refinement of surgical techniques was always accompanied by scientific documentation and evaluation. Jan encouraged the use of scoring systems. The knee rating instruments of his coworkers J. Lysholm and Y. Tegner have stood the test of time and are still widely used. The principle of evidence-based medicine is now accepted worldwide. It was practiced in Linköping already 30 years ago. However, Jan never lost sight of the needs of the individual patient, who is not represented by mean values and statistics. Already in 2004, in his 1-hour speech at the Surgical and Orthopaedic Congress in Berlin, he proclaimed not to forget the individual approach to every patient, taking into account not only scientific knowledge but also the ancient doctor's role of personal support. This approach is today called value-based medicine, aiming at the most effective treatment in the individual case.
      The members of the Gillquist group did not keep their knowledge to themselves. From 1975 on in Scandinavia, the Netherlands, and together with L. Johnson, R. Metcalf, R. O'Connor, and J. Hughston in the United States, Jan Gillquist was intensively involved in arthroscopy courses. Arthroscopy in Germany was influenced by Jan since 1982, when he started to lecture in Munich. J. Hughston, founder of the International Society of the Knee, included Jan in this group of elite knee surgeons. In the eighties and nineties, together with J. McGinty, K. DeHaven, R. Jackson, and D. Dandy, Jan Gillquist was lecturing around the world during many scientific congresses.
      In 1991 Jan Gillquist became the professor of sports medicine at Linköping University, being responsible not only for sports medicine but for the education in scientific theory for the entire university as well. Within only 8 years, his little department became one of the most successful of Linköping University, the only one regularly holding international courses. In 2007 Jan Gillquist was elected as a member of the Hall of Fame of the American Orthopaedic Society for Sports Medicine.
      In 2000 Jan retired from the university and immediately started a second career. Together with his former coworker and the great love of his life, Karola Messner, he transformed a 6-acre natural wilderness at the coast of the Baltic Sea into a beautiful garden with up to 750 visitors each year. The garden contains over 1,000 roses and 500 rhododendrons, as well as many rare plants and trees, and 10 life-size sculptures created by Karola Messner. They called it the Garden of Love (www.lilla-vik.se), and Jan stated that creating this garden was the most important thing he had done in his life. However, there was still time for more. Over and above the daily practical work in the garden, as well as planning and publications in Swedish plant and garden journals, he engaged passionately in the interpretation of the great European literature, mainly concentrating on Shakespeare.
      The worldwide arthroscopic community will remember Jan Gillquist as one of its most important pioneers (Fig 1).
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      Fig 1Jan Gillquist (photograph taken by Sven Kristiansen).
      The author thanks Karola Messner, M.D., Ph.D., for her kind support.