115 results found
Seewoonarain S, Ganesh D, Perera E, et al., 2023, Scaffold-associated procedures are superior to microfracture in managing focal cartilage defects in the knee: a systematic review & meta-analysis, Knee, Vol: 42, Pages: 320-338, ISSN: 0968-0160
BACKGROUND: Debate continues as to whether surgical treatment with chondral-regeneration devices is superior to microfracture for focal articular cartilage defects in the knee. PURPOSE: To evaluate the superiority of scaffold-associated chondral-regeneration procedures over microfracture by assessing: (1) Patient-reported outcomes; (2) Intervention failure; (3) Histological quality of cartilage repair. STUDY DESIGN: A three-concept keyword search strategy was designed, in accordance with PRISMA guidelines: (i) knee (ii) microfracture (iii) scaffold. Four databases (Ovid Medline, Embase, CINAHL and Scopus) were searched for comparative clinical trials (Level I-III evidence). Critical appraisal used two Cochrane tools: the Risk of Bias tool (RoB2) for randomized control trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I). Study heterogeneity permitted qualitative analysis with the exception of three patient-reported scores, for which a meta-analysis was performed. RESULTS: Twenty-one studies were identified (1699 patients, age range 18-66 years): ten randomized control trials and eleven non-randomized study interventions. Meta-analyses of the International Knee Documentation Committee (IKDC), Knee Injury And Osteoarthritis Outcome Score (KOOS) for pain and activities of daily living, and Lysholm score demonstrated statistically significant improvement in outcomes for scaffold procedures compared to microfracture at two years. No statistical difference was seen at five years. CONCLUSION: Despite the limitations of study heterogeneity, scaffold-associated procedures appear to be superior to MF in terms of patient-reported outcomes at two years though similar at five years. Future evaluation would benefit from studies using validated clinical scoring systems, reporting failure, adverse events and long-term clinical follow up to determine technique safety and superiority.
Jaggard MKJ, Boulange CL, Graca G, et al., 2023, The effect of liquid-liquid extraction on metabolite detection and analysis using NMR spectroscopy in human synovial fluid, JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS, Vol: 226, ISSN: 0731-7085
Ruparell K, Barve R, Tas RN, et al., 2022, Motivators and deterrents for early career female doctors applying to surgical training programmes in the UK National Health Service: a mixed-methods study, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Chew E, Sharma A, Gupte C, 2022, Triple dislocation around the knee joint: a case report, JOURNAL OF MEDICAL CASE REPORTS, Vol: 16
Bhattacharyya R, Al-Obaidi B, Sugand K, et al., 2021, Evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool in a real-time simulation setting (Distributed Interactive Simulation): a randomized controlled trial, INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, Vol: 52, Pages: 3420-3426, ISSN: 0020-1383
Karamchandani U, Bhattacharyya R, Patel R, et al., 2021, Training Surgeons to Perform Arthroscopic All-Inside Meniscal Repair: A Randomized Controlled Trial Evaluating the Effectiveness of a Novel Cognitive Task Analysis Teaching Tool, Imperial College London/University College London Meniscus Repair Cognitive Task Analysis (IUMeRCTA), AMERICAN JOURNAL OF SPORTS MEDICINE, Vol: 49, Pages: 2341-2350, ISSN: 0363-5465
Edwards TC, Naqvi AZ, Dela Cruz N, et al., 2021, Predictors of Pediatric Anterior Cruciate Ligament Injury: The Influence of Steep Lateral Posterior Tibial Slope and Its Relationship to the Lateral Meniscus, ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, Vol: 37, Pages: 1599-1609, ISSN: 0749-8063
The number of paediatric anterior cruciate ligament injuries is rising at a greater rate than in the adult population, as a result of the increased participation of children and adolescents in sports. This review explores the key presentations, diagnostic and management plans, and prevention methods associated with paediatric anterior cruciate ligament injuries. This injury presents as an acute pop and effusion, with limitations in gait, and can be extremely debilitating. Clinical examination and magnetic resonance imaging are used to diagnose the injury. The pivot shift and Lachman test remain the most valid exams when suspecting an anterior cruciate ligament tear. Management of the injury can be surgical or non-surgical depending on the severity of the tear and associated injuries. The surgical approach chosen is determined by the patient's Tanner classification, considering potential damage to the physes of the bone. Management plans should include rehabilitation consisting of strength, proprioception and neuromuscular training, to maximise the patient's recovery. Injury prevention programmes, consisting of strength training and neuromuscular training, should be followed by young athletes to reduce anterior cruciate ligament injuries. Compliance and earlier implementation coupled with an understanding of the biomechanics of anterior cruciate ligament injuries and verbal feedback maximise the benefit of neuromuscular training.
Bogomolova K, Sam AH, Misky AT, et al., 2021, Development of a virtual three-dimensional assessment scenario for anatomical education, Anatomical Sciences Education, Vol: 14, Pages: 385-393, ISSN: 1935-9772
In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.
Jaggard MKJ, Boulange CL, Graca G, et al., 2021, The influence of sample collection, handling and low temperature storage upon NMR metabolic profiling analysis in human synovial fluid, JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS, Vol: 197, ISSN: 0731-7085
Akhbari P, Jaggard MK, Boulange CL, et al., 2021, Differences between infected and noninfected synovial fluid, BONE & JOINT RESEARCH, Vol: 10, Pages: 85-95, ISSN: 2046-3758
Ahmad K, Bhattacharyya R, Gupte C, 2020, Using Cognitive Task Analysis to train Orthopaedic Surgeons - Is it time to think differently? A systematic review., Ann Med Surg (Lond), Vol: 59, Pages: 131-137, ISSN: 2049-0801
BACKGROUND: Working time restraints; senior led care; and a reduction in 'out of hours' operating has resulted in less operating time for orthopaedic trainees in the United Kingdom. Therefore, there has been an attempt to overcome these challenges by implementing novel techniques. Cognitive Task Analysis (CTA) focuses on the mental steps required to complete complex procedures. It has been used in training athletes and in general surgery but is new to orthopaedic training. AIM: To undertake a systematic review to analyse if CTA is beneficial to train novice surgeons in common orthopaedic and trauma procedures. MATERIALS AND METHODS: A systematic review was performed evaluating CTA in trauma and orthopaedic surgery on MEDLINE and EMBASE. Search terms used were: 'Cognitive task', 'mental rehearsal' and 'Orthop*'']. 33 studies were originally identified. Duplicate studies were excluded (11). Articles not relating to Orthopaedic surgery were excluded (15). The CTA research ranking scale was used to evaluate the impact of the studies included. RESULTS: 7 studies were identified as appropriate for inclusion. 264 participants. 178 M, 86F. All studies showed objective or subjective benefits from CTA in orthopaedic training when compared to traditional methods. The majority of the participants highlighted high subjective satisfaction with the use of the CTA tools and reported that they proved to be excellent adjuncts to the traditional apprenticeship model. CONCLUSION: CTA learning tools have demonstrated significant objective and subjective benefits in trauma and orthopaedic training. It is cost effective, easily accessible and allows repeated practice which is key in simulation training.
Jaggard MKJ, Boulange CL, Graca G, et al., 2020, Can metabolic profiling provide a new description of osteoarthritis and enable a personalised medicine approach?, CLINICAL RHEUMATOLOGY, Vol: 39, Pages: 3875-3882, ISSN: 0770-3198
Akhbari P, Karamchandani U, Jaggard MKJ, et al., 2020, Can joint fluid metabolic profiling (or "metabonomics") reveal biomarkers for osteoarthritis and inflammatory joint disease? A SYSTEMATIC REVIEW, BONE & JOINT RESEARCH, Vol: 9, Pages: 108-119, ISSN: 2046-3758
Akhbari P, Jaggard MK, Boulange CL, et al., 2019, Differences in the composition of hip and knee synovial fluid in osteoarthritis: a nuclear magnetic resonance (NMR) spectroscopy study of metabolic profiles, OSTEOARTHRITIS AND CARTILAGE, Vol: 27, Pages: 1768-1777, ISSN: 1063-4584
Logishetty K, Gofton WT, Rudran B, et al., 2019, A Multicenter Randomized Controlled Trial Evaluating the Effectiveness of Cognitive Training for Anterior Approach Total Hip Arthroplasty., J Bone Joint Surg Am
BACKGROUND: For total hip arthroplasty (THA), cognitive training prior to performing real surgery may be an effective adjunct alongside simulation to shorten the learning curve. This study sought to create a cognitive training tool (CTT) to perform anterior approach (AA)-THA, which was validated by expert surgeons, and test its use as a training tool compared with conventional material. METHODS: We employed a modified Delphi method with 4 expert surgeons from 3 international centers of excellence. Surgeons were independently observed performing THA before undergoing semistructured cognitive task analysis (CTA) and before completing successive rounds of surveys until a consensus was reached. Thirty-six surgical residents (postgraduate year [PGY]-1 through PGY-4) were randomized to cognitive training or training with a standard operation manual with surgical videos before performing a simulated AA-THA. RESULTS: The consensus CTA defined THA in 11 phases, in which were embedded 46 basic steps, 36 decision points, and 42 critical errors and linked strategies. This CTA was mapped onto an open-access web-based CTT. Surgeons who prepared with the CTT performed a simulated THA 35% more quickly (time, mean 28 versus 38 minutes) with 69% fewer errors in instrument selection (mean 29 versus 49 instances), and required 92% fewer prompts (mean 13 versus 25 instances). They were more accurate in acetabular cup orientation (inclination error, mean 8° versus 10°; anteversion error, mean 14° versus 22°). CONCLUSIONS: This validated CTT for arthroplasty provides structure for competency-based learning. It is more effective at preparing orthopaedic trainees for a complex procedure than conventional materials, as well as for learning sequence, instrumentation utilization, and motor skills. CLINICAL RELEVANCE: Cognitive training combines education on decision-making, knowledge, and technical skill. It is an inexpensive technique to teach surgeons to perform hip arthropla
Babu S, Gupte C, Gajjar S, et al., 2019, The 'sentinel' vessel: an anatomical landmark to identify the pes anserinus during hamstrings harvest for ACL reconstruction, EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY, Vol: 29, Pages: 1115-1118, ISSN: 1633-8065
Sugand K, Malik HH, Newman S, et al., 2019, Does using anatomical models improve patient satisfaction in orthopaedic consenting? Single-blinded randomised controlled trial, SURGEON-JOURNAL OF THE ROYAL COLLEGES OF SURGEONS OF EDINBURGH AND IRELAND, Vol: 17, Pages: 146-155, ISSN: 1479-666X
Sabharwal S, Archer S, Cadoux-Hudson D, et al., 2019, Exploring elderly patients' experiences of recovery following complex proximal humerus fracture: A qualitative study., J Health Psychol, Pages: 1359105319850883-1359105319850883
This study explores the experiences and perceptions of recovery in elderly patients who had sustained a proximal humerus fracture. In-depth semi-structured interviews were conducted with 15 patients over the age of 65. Thematic analysis identified aspects of care that impacted upon patient experience and quality of life. Seven main patient-reported themes were identified, including pain, sleep, shoulder function, emotional state, social support, relationship with their professional and experience of healthcare institution. These themes offer insight into the experiences of adults receiving care for proximal humerus fracture and highlight that existing quantitative measures of quality of life do not measure domains that are important to patients.
Khanna M, Gupte C, Dodds A, et al., 2019, Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee, SKELETAL RADIOLOGY, Vol: 48, Pages: 729-740, ISSN: 0364-2348
Jaggard MKJ, Boulange CL, Akhbari P, et al., 2019, A systematic review of the small molecule studies of osteoarthritis using nuclear magnetic resonance and mass spectroscopy, OSTEOARTHRITIS AND CARTILAGE, Vol: 27, Pages: 560-570, ISSN: 1063-4584
The posterolateral corner (PLC) of the knee refers to a complex of structures that play a key role in knee stability. The main three structures in the PLC of the knee are the lateral collateral ligament, the popliteus and the popliteofibular ligament. These are primarily restraints to varus and external rotation forces. As such, mechanisms of injury include varus and hyperextension, and are typically high energy. These injuries are rarely isolated and are commonly associated with other injuries such as cruciate ligament injury or tibiofemoral knee dislocation. If undetected or untreated, PLC injuries can cause severe long-term disability due to instability and cartilage degeneration. Failure to recognize these injuries can also jeopardize the results of concomitant anterior or posterior cruciate ligament reconstruction. Immediate management in acute injuries involves assessment and treatment of any associated neurovascular injury, especially to the popliteal artery or peroneal nerve, and reduction of knee dislocation. Acute repairs of the damaged structures can be undertaken, but ligament reconstruction is often required, using either autograft or allograft. Graft reconstruction procedures can be fibula-based or anatomic, each having their own merits. The timing of surgery can be acute, chronic or staged, depending on the exact nature of the injury and on timing.
Karia M, Ghaly Y, Al-Hadithy N, et al., 2019, Current concepts in the techniques, indications and outcomes of meniscal repairs., Eur J Orthop Surg Traumatol, Vol: 29, Pages: 509-520
Knee arthroscopy for meniscal tears is one of the most commonly performed orthopaedic procedures. In recent years, there has been an increasing incidence of meniscal repairs, as there are concerns that meniscectomy predisposes patients to early osteoarthritis. Indications for meniscal repair are increasing and can now be performed in older patients who are active, even if the tear is in the avascular zone. Options for meniscal tear management broadly fall into three categories: non-operative management, meniscal repair or meniscectomy. With limited evidence directly comparing each of these options optimal management strategies can be difficult. Decision making requires thorough assessment of patient factors (e.g. age and comorbidities) and tear characteristics (e.g. location and reducibility). The purpose of this paper is, therefore, to review the management options of meniscal tears and summarize the evidence for meniscal tear repair.
Stevenson H, Jaggard M, Akhbari P, et al., 2019, The role of denatured synovial fluid proteins in the lubrication of artificial joints, Biotribology, Vol: 17, Pages: 49-63, ISSN: 2352-5738
CoCrMo ball-on-flat wear tests were carried out with 25 wt% bovine calf serum (25BCS) and human synovial fluid (HSF) to investigate artificial joint lubricating mechanisms. Post-test the wear scar on the disc was measured and surface deposits in and around the rubbed region were analysed by Micro InfraRed Reflection Absorption Spectroscopy (Micro-IRRAS). In most tests the HSF samples gave higher wear than the 25BCS solution; in some cases, up to 77%. After rinsing a similar pattern of surface deposits was observed in and around the wear scar for both the model and HSF. Micro-IRRAS showed the deposits were primarily denatured proteins with an increased β-sheet content. In some cases, trans-alkyl chain/carbonyl components were also present and these were assigned to lipids. Thioflavin T fluorescent imaging also indicated aggregated non-native β-sheet fibrils were present in the deposits and their presence was associated with lower wear. The formation of insoluble, denatured protein films is thought to be the primary lubrication mechanism contributing to surface protection during rubbing. From this and earlier work we suggest inlet shear induces denaturing of proteins resulting in the formation of non-native β-sheet aggregates. This material is entrained into the contact region where it forms the lubricating film. Patient synovial fluid chemistry appears to influence wear, at least in the bench test, and thus could contributes to increased risk of failure, or success, with metal-metal hips. Finally using 25BCS as a reference screening fluid gives an overly optimistic view of wear in these systems.
Sugand K, Berry M, Yusuf I, et al., 2019, Oxford Handbook for Medical School, Publisher: Oxford University Press, USA, ISBN: 9780199681907
This handbook includes quick-access summaries covering the crucial information for your preclinical years and for each clinical specialty.
Bhattacharyya R, Davidson DJ, Sugand K, et al., 2018, Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool., JBJS Essent Surg Tech, Vol: 8, Pages: e32-e32, ISSN: 2160-2204
Background: Virtual reality and cadaveric simulations are expensive and not readily accessible1. Innovative and accessible training adjuncts are required to help meet training needs. Cognitive task analysis (CTA) has been used extensively to train pilots and surgeons in other surgical specialties2-6. However, the use of CTA tools within orthopaedics is in its infancy. Arthroscopic procedures are minimally invasive and require a different skill set compared with open surgery. Residents often feel poorly prepared to perform this in the operating room because of the steep learning curve associated with acquiring basic arthroscopic skills. We designed the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) tool, which is, to our knowledge, the first CTA tool described in the orthopaedic literature, demonstrating significant objective benefits in training novices to perform diagnostic knee arthroscopy. Description: The IKACTA tool, which is the combination of the written description of the phases below and the videos (with superimposed audio recordings) of each phase, utilizes simultaneous written and audiovisual modalities to teach diagnostic knee arthroscopy. The procedure was divided into 7 phases: (1) operating room and patient setup, (2) preparation and draping, (3) anterolateral portal placement, (4) examination of the patellofemoral joint and the lateral gutter, (5) examination of the medial compartment and anteromedial portal placement, (6) examination of the intercondylar notch and the lateral compartment, and (7) postoperative care and rehabilitation.For each phase, there are sections on the technical steps, cognitive decision-making behind each technical step, and potential errors and solutions. Video clips recorded by an expert surgeon in the operating room specific to each phase and audio voice recordings explaining each phase superimposed on the video clips were combined with the written information to design the IKACTA tool. Alternatives: Not applic
Bhattacharyya R, Sugand K, Al-Obaidi B, et al., 2018, Trauma simulation training: a randomized controlled trial -evaluating the effectiveness of the Imperial Femoral Intramedullary Nailing Cognitive Task Analysis (IFINCTA) tool, Acta Orthopaedica, Vol: 89, Pages: 689-695, ISSN: 1745-3674
Background and purpose - Cognitive task analysis (CTA) has been used extensively to train pilots and in other surgical specialties. However, the use of CTA within orthopedics is in its infancy. We evaluated the effectiveness of a novel CTA tool to improve understanding of the procedural steps in antegrade femoral intramedullary nailing. Material and methods - Design: A modified Delphi technique was used to generate a CTA from 3 expert orthopedic trauma surgeons for antegrade femoral intramedullary nailing. The written and audiovisual information was combined to describe the technical steps, decision points, and errors for each phase of this procedure Validation: A randomized double-blind controlled trial was undertaken with 22 medical students (novices) randomized into 2 equal groups. The intervention group were given the CTA tool and the control group were given a standard operative technique manual. They were assessed using the validated "Touch Surgery™" application assessment tool on femoral intramedullary nailing. Results - The pre-test scores between the two groups were similar. However, the post-test scores were statistically significantly better in the intervention group compared with the control group. The improvement (post-test median scores) in the intervention group compared with the control group was 20% for patient positioning and preparation, 21% for femoral preparation, 10% for proximal locking, and 19% for distal locking respectively (p < 0.001 for all comparisons). Interpretation - This is the first multimedia CTA tool in femoral intramedullary nailing that is easily accessible, user-friendly, and has demonstrated significant benefits in training novices over the traditional use of operative technique manuals.
Lord BR, Colaco HB, Gupte CM, et al., 2018, ACL graft compression: a method to allow reduced tunnel sizes in ACL reconstruction, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 26, Pages: 2430-2437, ISSN: 0942-2056
PURPOSE: A common problem during ACL reconstruction is asymmetry of proximal-distal graft diameter leading to tunnel upsizing and graft-tunnel mismatch. Compression downsizing provides a graft of uniform size, allowing easy passage into a smaller tunnel. The purpose of this study was to quantify the graft compression technique and its effects on graft biomechanics and stability. It was hypothesised that compression downsizing would significantly reduce cross-sectional area (CSA); that no significant changes in graft biomechanics would occur; graft fixation stability would be improved. METHOD: Sixty-eight non-irradiated peroneus longus (PL) tendons were investigated. Twenty were halved and paired into ten four-strand grafts, 20 strands were compressed by 0.5-1 mm diameter and changes in CSA recorded using an alginate mould technique. The following properties were compared with 20 control strands: cyclic strain when loaded 70-220 N for 1000 cycles; stiffness; ultimate tensile load and stress; Young's modulus. 24 PL tendons were quadrupled into grafts, 12 were compressed and all 24 were submerged in Ringer's solution at 37 °C and the CSA recorded over 12 h. Twelve compressed and 12 control quadrupled grafts were mounted in porcine femurs, placed in Ringer's solution for 12 h at 37 °C and graft displacement at the bone tunnel aperture recorded under cyclic loading. RESULTS: Mean decreases in CSA of 31% under a stress of 471 kPa and 21% under a stress of 447 kPa were observed for doubled and quadrupled grafts, respectively. Compressed grafts re-expanded by 19% over 12 h compared to 2% for controls. No significant differences were observed between compressed and control grafts in the biomechanical properties and graft stability; mean cyclic displacements were 0.3 mm for both groups. CONCLUSIONS: No detrimental biomechanical effects of graft compression on allograft PL tendons were observed. Following compression, t
Stevenson H, Parkes M, Austin L, et al., 2018, The development of a small-scale wear test for CoCrMo specimens with human synovial fluid, Biotribology, Vol: 14, Pages: 1-10, ISSN: 2352-5738
A new test was developed to measure friction and wear of hip implant materials under reciprocating sliding conditions. The method requires a very small amount of lubricant (<3 ml) which allows testing of human synovial fluid. Friction and wear of Cobalt Chromium Molybdenum (CoCrMo) material pairs were measured for a range of model and human synovial fluid samples. The initial development of the test assessed the effect of fluid volume and bovine calf serum (BCS) concentration on friction and wear. In a second series of tests human synovial fluid (HSF) was used. The wear scar size (depth and volume) on the disc was dependent on protein content and reduced significantly for increasing BCS concentration. The results showed that fluid volumes of <1.5 ml were affected by evaporative loss effectively increasing the protein concentration resulting in anomalously lower wear. At the end of the test thick deposits were observed in and around the wear scars on the disc and ball; these were analysed by Infrared Reflection-Absorption Spectroscopy. The deposits were composed primarily of denatured proteins and similar IR spectra were obtained from the BCS and HSF tests. The analysis confirmed the importance of SF proteins in determining wear of CoCrMo couples.
Gupte CM, 2017, Knee Arthroscopy SimulationA Randomized Controlled Trial Evaluating the Effectiveness of the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool, Journal of Bone and Joint Surgery, American Volume, ISSN: 0021-9355
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