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Journal articleAgbesi MPK, Borsuk HS, Hunt JN, et al., 2017,
Motion-driven flow in an unusual piscine nasal region
, Zoology, Vol: 119, Pages: 500-510, ISSN: 0944-2006 -
Conference paperGreen A, Salman M, Yentis S, et al., 2017,
Trainer/trainee trainer training
, Association-of-Anaesthetists-of-Great-Britain-and-Ireland (AAGBI) GAT Annual Scientific Meeting, Publisher: WILEY, Pages: 81-81, ISSN: 0003-2409 -
Journal articleDuffell LD, Jordan SJ, Cobb JP, et al., 2017,
Gait adaptations with aging in healthy participants and people with knee joint osteoarthritis
, Gait and Posture, Vol: 57, Pages: 246-251, ISSN: 0966-6362The relationship between age and gait characteristics in people with and without medial compartment osteoarthritis (OA) remains unclear. We aimed to characterize this relationship and to relate biomechanical and structural parameters in a subset of OA patients. Twenty five participants with diagnosed unilateral medial knee OA and 84 healthy participants, with no known knee pathology were recruited. 3D motion capture was used to analyse sagittal and coronal plane gait parameters while participants walked at a comfortable speed. Participants were categorized according to age (18–30, 31–59 and 60+ years), and those with and without OA were compared between and within age groups. In a subset of OA patients, clinically available Computed Tomography images were used to assess joint structure. Differences in coronal plane kinematics at the hip and knee were noted in participants with OA particularly those who were older compared with our healthy controls, as well as increased knee moments. Knee adduction moment correlated with structural parameters in the subset of OA patients. Increased knee moments and altered kinematics were observed in older participants presenting with OA only, which seem to be related to morphological changes in the joint due to OA, as opposed to being related to the initial cause of medial knee OA.
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Journal articleLong MJ, Papi E, Duffell LD, et al., 2017,
Predicting knee osteoarthritis risk in injured populations
, Clinical Biomechanics, Vol: 47, Pages: 87-95, ISSN: 1879-1271BackgroundIndividuals who suffered a lower limb injury have an increased risk of developing knee osteoarthritis. Early diagnosis of osteoarthritis and the ability to track its progression is challenging. This study aimed to explore links between self-reported knee osteoarthritis outcome scores and biomechanical gait parameters, whether self-reported outcome scores could predict gait abnormalities characteristic of knee osteoarthritis in injured populations and, whether scores and biomechanical outcomes were related to osteoarthritis severity via Spearman's correlation coefficient.MethodsA cross-sectional study was conducted with asymptomatic participants, participants with lower-limb injury and those with medial knee osteoarthritis. Spearman rank determined relationships between knee injury and outcome scores and hip and knee kinetic/kinematic gait parameters. K-Nearest Neighbour algorithm was used to determine which of the evaluated parameters created the strongest classifier model.FindingsDifferences in outcome scores were evident between groups, with knee quality of life correlated to first and second peak external knee adduction moment (0.47, 0.55). Combining hip and knee kinetics with quality of life outcome produced the strongest classifier (1.00) with the least prediction error (0.02), enabling classification of injured subjects gait as characteristic of either asymptomatic or knee osteoarthritis subjects. When correlating outcome scores and biomechanical outcomes with osteoarthritis severity only maximum external hip and knee abduction moment (0.62, 0.62) in addition to first peak hip adduction moment (0.47) displayed significant correlations.InterpretationThe use of predictive models could enable clinicians to identify individuals at risk of knee osteoarthritis and be a cost-effective method for osteoarthritis screening.
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Journal articleRiviere C, Hardijzer A, Lazennec J-Y, et al., 2017,
Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review
, ORTHOPAEDICS & TRAUMATOLOGY-SURGERY & RESEARCH, Vol: 103, Pages: 549-557, ISSN: 1877-0568- Author Web Link
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Journal articleNg CTJ, Newman S, Harris S, et al., 2017,
Patient-specific instrumentation improves alignment of lateral unicompartmental knee replacements by novice surgeons.
, International Orthopaedics, Vol: 41, Pages: 1379-1385, ISSN: 0341-2695PurposePatient-specific instrumentation (PSI) has the potential to offer numerous benefits—not least of all, improved resection accuracy; but its potential has not been realised in clinical studies. An explanation may be the focus of such studies on the total knee replacement (TKR—a common procedure, with which surgeons are generally very familiar. Consequently, we sought to investigate the potential role of PSI in guiding novice surgeons to perform the more technically demanding and less familiar lateral unicondylar knee replacement (LUKR).MethodsTwelve orthopaedic trainees naive to LUKR were instructed to perform the procedure according to a pre-operative plan. These were carried out on synthetic sawbones and were completed once with conventional instrumentation alone and once with the adjunct of PSI, allowing a comparison of the plan adherence achieved by the two sets of instrumentation.ResultsThere was a tendency for PSI to demonstrate improved plan adherence, though a statistically significant improvement was only seen in compound rotational error of the femoral implant (p = 0.004). PSI was, however, able to produce narrower standard deviations in the mean translational displacement of the femoral implant and also the mean rotational displacement of both implants, suggesting a higher degree of precision.ConclusionsOur study provides some evidence that PSI can improve the ability of novice surgeons to replicate a pre-operative plan, but our results suggest the need for larger-scale clinical studies to establish the role of PSI in this procedure.
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Journal articleWilliams A, Stephen J, Kittl C, et al., 2017,
The Role of the Lateral Soft Tissues in Controlling Anterior Translation And Internal Rotation of the Tibia, and An Investigation of Lateral Reconstructions Accompanying ACL Reconstruction
, Orthopaedic journal of sports medicine, Vol: 5, ISSN: 2325-9671<h4>Introduction:</h4> There is considerable current interest in the role of the lateral soft tissue structures in the context of ACL deficiency (ACLD). Of course the topic is not new but a re-visitation, although with improved experimental techniques available. It was clear that there was a rush to create surgical techniques based on the ‘Anterolateral Ligament’ (ALL) but without investigative ‘due-diligence’ and without consideration that other structures may be important, or more important. <h4>Objectives:</h4> To study the anatomy and biomechanics of the lateral soft tissues relevant to the ACL and ACL reconstruction techniques investigating isometricity, structures’ contributions to resistance of anterior tibial translation (ATT), internal rotation (IR), and pivot shift (PS). Also we studied the impact of various reconstructions on restoration of kinematics and potential over-constraint and effects on articular surface compression load. <h4>Methods:</h4> Several studies were undertaken. In all healthy fresh-frozen cadaveric specimens were used. Descriptive anatomy was described. Length changes of suture fixed at structure and reconstruction attachment points on the tibia and femur were measured with linear variable displacement transducers (LVDTs). To investigate structures’ contribution to resist translation and torque a 6-degrees of freedom robot with a universal force-moment sensor was used in a classic ‘cutting study’. The robot replayed the same movement with sequential sectioning of structures recording the decrease in force / torque needed to reach the same movement limit. In this way the structure’s resistance to motion as a percentage of the total could be calculated. In other studies knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Joint surface compression was measured w
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Journal articleFeola AJ, Coudrillier B, Mulvihill J, et al., 2017,
Deformation of the Lamina Cribrosa and Optic Nerve Due to Changes in Cerebrospinal Fluid Pressure
, INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Vol: 58, Pages: 2070-2078, ISSN: 0146-0404 -
Journal articleIranpour F, Merican AM, Teo SH, et al., 2017,
Femoral articular geometry and patellofemoral stability
, KNEE, Vol: 24, Pages: 555-563, ISSN: 0968-0160Background:Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry.Methods:Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175 N and 30 N, respectively. The force required to displace the patella 10 mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum.Results:The lateral facet slope decreased progressively with flexion from 23° ± 3° (mean ± S.D.) at 0° to 17 ± 5° at 90°. While the medial facet angle increased progressively from 8° ± 8° to 36° ± 9° between 0° and 90°. Patellar lateral stability varied from 96 ± 22 N at 0°, to 77 ± 23 N at 20°, then to 101 ± 27 N at 90° knee flexion. Medial stability varied from 74 ± 20 N at 0° to 170 ± 21 N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r = 0.78, p < 0.0001).Conclusions:These results provide objective evidence relating the changes of femoral profile geometry with knee flexion to patellofemoral stability.
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Journal articleMcGregor AH, 2017,
Injury prevention, performance and return to sport: How can science help?
, Chinese Journal of Traumatology, Vol: 20, Pages: 63-66, ISSN: 1008-1275 -
Journal articleMa S, Goh EL, Jin A, et al., 2017,
Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties
, Scientific Reports, Vol: 7, Pages: 1-10, ISSN: 2045-2322Osteoporosis is characterised by trabecular bone loss resulting from increased osteoclast activation and unbalanced coupling between resorption and formation, which induces a thinning of trabeculae and trabecular perforations. Bisphosphonates are the frontline therapy for osteoporosis, which act by reducing bone remodelling, and are thought to prevent perforations and maintain microstructure. However, bisphosphonates may oversuppress remodelling resulting in accumulation of microcracks. This paper aims to investigate the effect of bisphosphonate treatment on microstructure and mechanical strength. Assessment of microdamage within the trabecular bone core was performed using synchrotron X-ray micro-CT linked to image analysis software. Bone from bisphosphonate-treated fracture patients exhibited fewer perforations but more numerous and larger microcracks than both fracture and non-fracture controls. Furthermore, bisphosphonate-treated bone demonstrated reduced tensile strength and Young’s Modulus. These findings suggest that bisphosphonate therapy is effective at reducing perforations but may also cause microcrack accumulation, leading to a loss of microstructural integrity and consequently, reduced mechanical strength.
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Journal articleKotti M, Duffell LD, Faisal AA, et al., 2017,
Detecting knee osteoarthritis and its discriminating parameters using random forests
, Medical Engineering and Physics, Vol: 43, Pages: 19-29, ISSN: 1350-4533This papertackles the problem of automatic detection of knee osteoarthritis. A computer system is built that takes as input the body kinetics and produces as output not only an estimation of presence of the knee osteoarthritis,as previouslydone inthe literature, but alsothe most discriminating parameters along with a set of rules on how this decision was reached.This fills the gap of interpretability between the medical and the engineering approaches. We collected locomotion data from 47 subjects with knee osteoarthritis and 47 healthy subjects.Osteoarthritis subjects were recruited from hospital clinics and GP surgeries, and age and sex matched heathy subjects from the local community. Subjects walked on a walkway equippedwith two force plates with piezoelectric 3-component force sensors. Parameters of the vertical, anterior-posterior, and medio-lateral ground reaction forces, such asmean value, push-off time, and slope,were extracted. Then random forest regressors map thoseparameters via rule induction to the degree of knee osteoarthritis.To boost generalisation ability,a subject-independent protocol is employed.The 5-fold cross-validated accuracy is 72.61%±4.24%. We show that with 3 steps or lessa reliable clinical measure can be extractedin a rule-based approachwhen the dataset is analysed appropriately.
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Journal articleLogishetty K, 2017,
Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach
, BMJ Quality Improvement Reports, Vol: 6, ISSN: 2050-1315Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments.This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation. We discuss Whole Systems Measures applicable to VFCs, to consider how robust and specific data collection can progress this care model.Three Plan-Do-Study-Act cycles led to a change in practice over a 21-month period. Our target for uptake of new patients seen in VFCs within 6 months of starting was set at 50%. It increased from 0% to 56.1% soon after introduction, and plateaued at an average of 56.4% in the six-months before the end of the study period.Careful planning, frequent monitoring, and gathering feedback from a multidisciplinary team of varying seniority, were the important factors in transitioning to, and sustaining, a successful VFC model.
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Conference paperBoughton OR, Zhao S, Arnold M, et al., 2017,
Measuring bone stiffness using microindentation
, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 31-31, ISSN: 2049-4416 -
Journal articleGreen A, Salman M, Yentis S, et al., 2017,
Ergonomics and posture of midwives, obstetricians and anaesthetists on labour ward
, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].
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Journal articleGreen A, Salman M, Yentis S, et al., 2017,
Musculoskeletal aches and pains reported by labour ward staff
, Anaesthesia, Vol: 72, Pages: 82-82, ISSN: 0003-2409Awkward body postures and the progressive accumulation of muscle fatigue are known risk factors for the development of injury, with most work-related musculoskeletal disorders developing over time [1]. Work-related disorders can develop while carrying out normal physical work activities and are associated with fixed or constrained body positions and continual repetition of movements [1]. Heavy workloads on the maternity unit often require staff to perform physically demanding activities under pressure and adopt suboptimal postures. Simple ergonomic intervention such as providing suitable adjustable seating and the appropriate layout of equipment can reduce injuries, reduce sickness absence and improve productivity [2].
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Journal articleNazruzov T, Van Der Straeten C, Iranpour Boroujeni F, et al.,
REGISTRATION OF PRE- AND POST-OPERATIVE CT DATA USING ICP FOR PATIENTS UNDERGOING TOTAL KNEE ARTHROPLASTY (TKA)
, Bone & Joint Journal, ISSN: 2049-4394 -
Conference paperMa S, Goh EL, Patel B, et al., 2016,
Are the cracks starting to appear in bisphosphonate therapy?
, British Orthopaedic Research Society (BORS) 2016 Conference, Publisher: British Editorial Society of Bone and Joint Surgery, Pages: 53-53, ISSN: 2049-4416 -
Journal articleSabharwal S, Patel NK, Griffiths D, et al., 2016,
Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus
, Bone & Joint Research, Vol: 5, Pages: 470-480, ISSN: 2046-3758Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes.Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009).Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria.
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Journal articleLord BR, El-Daou H, Sabnis BM, et al., 2016,
Erratum to: Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction (vol 25, pg 559, 2017)
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 988-988, ISSN: 0942-2056Purpose: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery.Methods: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus.Results: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout.Conclusion: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the nativ
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