ESSKA has grown significantly from a small society of a few hundred members run out of the president's home office to a large international institution with over 3,000 members from over 100 countries. Key developments include establishing a professional office, expanding the board, increasing membership, improving the journal, creating an education portal and book program, strengthening sections/committees, growing fellowship programs, conducting consensus initiatives, affiliating national societies, and founding a foundation to support projects and poorer countries. However, there is still more to be done, such as accommodating new committees on hip arthroscopy and osteotomy.