Publications
119 results found
Khatri C, Sugand K, Anjum S, et al., 2014, Does Video Gaming Affect Orthopaedic Skills Acquisition? A Prospective Cohort-Study, PLOS ONE, Vol: 9, ISSN: 1932-6203
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- Citations: 6
Mordecai SC, Al-Hadithy N, Ware HE, et al., 2014, Treatment of meniscal tears: An evidence based approach., World J Orthop, Vol: 5, Pages: 233-241, ISSN: 2218-5836
Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.
Bayona S, Akhtar K, Gupte C, et al., 2014, Assessing performance in shoulder arthroscopy: The Imperial Global Arthroscopy Rating Scale (IGARS), Journal of Bone and Joint Surgery: American Volume, Vol: 96A, ISSN: 0021-9355
Background: Surgical training is undergoing major changes with reduced resident work hours and an increasing focus on patient safety and surgical aptitude. The aim of this study was to create a valid, reliable method for an assessment of arthroscopic skills that is independent of time and place and is designed for both real and simulated settings. The validity of the scale was tested using a virtual reality shoulder arthroscopy simulator.Methods: The study consisted of two parts. In the first part, an Imperial Global Arthroscopy Rating Scale for assessing technical performance was developed using a Delphi method. Application of this scale required installing a dual-camera system to synchronously record the simulator screen and body movements of trainees to allow an assessment that is independent of time and place. The scale includes aspects such as efficient portal positioning, angles of instrument insertion, proficiency in handling the arthroscope and adequately manipulating the camera, and triangulation skills. In the second part of the study, a validation study was conducted. Two experienced arthroscopic surgeons, blinded to the identities and experience of the participants, each assessed forty-nine subjects performing three different tests using the Imperial Global Arthroscopy Rating Scale. Results were analyzed using two-way analysis of variance with measures of absolute agreement. The intraclass correlation coefficient was calculated for each test to assess inter-rater reliability.Results: The scale demonstrated high internal consistency (Cronbach alpha, 0.918). The intraclass correlation coefficient demonstrated high agreement between the assessors: 0.91 (p < 0.001). Construct validity was evaluated using Kruskal-Wallis one-way analysis of variance (chi-square test, 29.826; p < 0.001), demonstrating that the Imperial Global Arthroscopy Rating Scale distinguishes significantly between subjects with different levels of experience utilizing a virtual reali
Akhtar KSN, Chen A, Standfield NJ, et al., 2014, The role of simulation in developing surgical skills., Curr Rev Musculoskelet Med, Vol: 7, Pages: 155-160, ISSN: 1935-973X
Surgical training has followed the master-apprentice model for centuries but is currently undergoing a paradigm shift. The traditional model is inefficient with no guarantee of case mix, quality, or quantity. There is a growing focus on competency-based medical education in response to restrictions on doctors' working hours and the traditional mantra of "see one, do one, teach one" is being increasingly questioned. The medical profession is subject to more scrutiny than ever before and is facing mounting financial, clinical, and political pressures. Simulation may be a means of addressing these challenges. It provides a way for trainees to practice technical tasks in a protected environment without putting patients at risk and helps to shorten the learning curve. The evidence for simulation-based training in orthopedic surgery using synthetic models, cadavers, and virtual reality simulators is constantly developing, though further work is needed to ensure the transfer of skills to the operating theatre.
Gupte CM, Schaerf DA, Sandison A, et al., 2014, Neural Structures within Human Meniscofemoral Ligaments: A Cadaveric Study., ISRN Anatomy, Vol: 2014, ISSN: 2314-4726
Aim. To investigate the existence of neural structures within the meniscofemoral ligaments (MFLs) of the human knee. Methods. The MFLs from 8 human cadaveric knees were harvested. 5 μm sections were H&E-stained and examined under light microscopy. The harvested ligaments were then stained using an S100 monoclonal antibody utilising the ABC technique to detect neural components. Further examination was performed on 60–80 nm sections under electron microscopy. Results. Of the 8 knees, 6 were suitable for examination. From these both MFLs existed in 3, only anterior MFLs were present in 2, and an isolated posterior MFL existed in 1. Out of the 9 MFLs, 4 demonstrated neural structures on light and electron microscopy and this was confirmed with S100 staining. The ultrastructure of these neural components was morphologically similar to mechanoreceptors. Conclusion. Neural structures are present in MFLs near to their meniscal attachments. It is likely that the meniscofemoral ligaments contribute not only as passive secondary restraints to posterior draw but more importantly to proprioception and may therefore play an active role in providing a neurosensory feedback loop. This may be particularly important when the primary restraint has reduced function as in the posterior cruciate ligament—deficient human knee.
Dodds AL, Halewood C, Gupte CM, et al., 2014, The anterolateral ligament ANATOMY, LENGTH CHANGES AND ASSOCIATION WITH THE SEGOND FRACTURE, BONE & JOINT JOURNAL, Vol: 96B, Pages: 325-331, ISSN: 2049-4394
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- Citations: 299
Seah TET, Barrow A, Baskaradas A, et al., 2014, A Virtual Reality System to Train Image Guided Placement of Kirschner-Wires for Distal Radius Fractures, 6th International Symposium on Biomedical Simulation (ISBMS), Publisher: SPRINGER INT PUBLISHING AG, Pages: 20-29, ISSN: 0302-9743
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- Citations: 6
Tay C, Khajuria A, Gupte C, 2014, Simulation training: A systematic review of simulation in arthroscopy and proposal of a new competency-based training framework, INTERNATIONAL JOURNAL OF SURGERY, Vol: 12, Pages: 626-633, ISSN: 1743-9191
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- Citations: 59
Davidson DJ, Shaukat YM, Jenabzadeh R, et al., 2013, Spontaneous bilateral compartment syndrome in a HIV-positive patient., BMJ Case Rep, Vol: 2013
Spontaneous bilateral compartment syndrome is a very rare condition but one which requires swift diagnosis and urgent surgical decompression by fasciotomies in order to achieve the best outcome. We present the case of a 31-year-old HIV-positive man. The case highlights the perils of being sidetracked by an atypical clinical history instead of acting on the classical clinical examination findings. We will discuss the presentation and management of this patient, review the literature and highlight the key learning points. The most important learning point being that no matter how atypical the history, if a patient presents with limb pain out of proportion to the injury (with or without pain on passive stretch), sensory changes and a loss of motor power, then a diagnosis of acute compartment syndrome must be considered.
Davidson DJ, Clarke SG, Gupte CM, 2013, (i) Planning and consent for primary total knee replacement, Orthopaedics and Trauma, Vol: 27, Pages: 345-354, ISSN: 1877-1327
The aim of primary total knee replacement is to decrease pain, restore function and reduce disability. This is achieved by correct patient selection and adequate planning so that the appropriate prosthesis can be implanted in the appropriate manner. The technical goal of total knee arthroplasty is to implant a well-aligned prosthesis in a well-balanced knee, with linear patellar tracking and achieve infection-free healing.Weight bearing anteroposterior, lateral and patellofemoral joint radiographs are mandatory and standing long leg views help determine alignment. CT and MRI scans may be of value in assessing bone stock and ligamentous deficiency. If there is a lack of bone stock a stemmed prosthesis or augmentation wedges may be required, whilst a ligamentous deficiency may necessitate a stabilized or constrained prosthesis.The consent process for TKR commences at the outpatient consultation and must consider the reason for operation, alternative treatments, all common and serious risks and the rehabilitation protocol. There is an increasing use of multimedia tools (e.g. www.orthoconsent.com) in the consent process. © 2013 Elsevier Ltd.
Eftaxiopoulou T, Gupte CM, Dear JP, et al., 2013, The effect of digitisation of the humeral epicondyles on quantifying elbow kinematics during cricket bowling, JOURNAL OF SPORTS SCIENCES, Vol: 31, Pages: 1722-1730, ISSN: 0264-0414
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- Citations: 4
Al-Hadithy N, Dodds AL, Akhtar KSN, et al., 2013, Current concepts of the management of anterior cruciate ligament injuries in children, BONE & JOINT JOURNAL, Vol: 95B, Pages: 1562-1569, ISSN: 2049-4394
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- Citations: 27
Doolan K, Baskaradas A, Gupte C, 2013, Revalidation - What does it mean for surgical trainees?, Int J Surg, Vol: 11, Pages: 690-691
Gupte C, St Mart J-P, 2013, The acute swollen knee: diagnosis and management, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 106, Pages: 259-268, ISSN: 0141-0768
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- Citations: 5
Barrow A, Akhtar K, Gupte C, et al., 2013, Requirements analysis of a 5 degree of freedom haptic simulator for orthopedic trauma surgery., Stud Health Technol Inform, Vol: 184, Pages: 43-47, ISSN: 0926-9630
There are currently few Virtual Reality simulators for orthopedic trauma surgery. The current simulators provide only a basic recreation of the manual skills involved, focusing instead on the procedural and anatomical knowledge required. One factor limiting simulation of the manual skills is the complexity of adding realistic haptic feedback, particularly torques. This paper investigates the requirements, in terms of forces and workspace (linear and rotational), of a haptic interface to simulate placement of a lag screw in the femoral head, such as for fixation of a fracture in the neck of the femur. To measure these requirements, a study has been conducted involving 5 subjects with experience performing this particular procedure. The results gathered are being used to inform the design of a new haptic simulator for orthopedic trauma surgery.
Chen A, Gupte C, Akhtar K, et al., 2012, The global economic cost of osteoarthritis: how the UK compares, Arthritis, Vol: 2012, ISSN: 2090-1984
Aims. To examine all relevant literature on the economic costs of osteoarthritis in the UK, and to compare such costs globally. Methods. A search of MEDLINE was performed. The search was expanded beyond peer-reviewed journals into publications by the department of health, national orthopaedic associations, national authorities and registries, and arthritis charities. Results. No UK studies were identified in the literature search. 3 European, 6 North American, and 2 Asian studies were reviewed. Significant variation in direct and indirect costs were seen in these studies. Costs for topical and oral NSAIDs were estimated to be £19.2 million and £25.65 million, respectively. Cost of hip and knee replacements was estimated to exceed £850 million, arthroscopic surgery for osteoarthritis was estimated to be £1.34 million. Indirect costs from OA caused a loss of economic production over £3.2 billion, £43 million was spent on community services and £215 million on social services for osteoarthritis. Conclusions. While estimates of economic costs can be made using information from non-published data, there remains a lack of original research looking at the direct or indirect costs of osteoarthritis in the UK. Differing methodology in calculating costs from overseas studies makes direct comparison with the UK difficult.
Pearce S, Prince M, Gupte CM, et al., 2012, Pearce S, Prince M, Gupte CM, Singh S. Hindfoot plantarflexion: A radiographic aid to the diagnosis of tendoachilles rupture.
Pearce S, Gupte C, Singh S, et al., 2011, Hindfoot Plantarflexion: A Radiographic Aid to the Diagnosis of Achilles Tendon Rupture, JOURNAL OF FOOT & ANKLE SURGERY, Vol: 51, Pages: 176-178, ISSN: 1067-2516
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- Citations: 2
Dodds AL, Gupte CM, Neyret P, et al., 2011, Extra-articular techniques in anterior cruciate ligament reconstruction A LITERATURE REVIEW, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 93B, Pages: 1440-1448, ISSN: 0301-620X
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- Citations: 92
Dodds AL, Gupte CM, Neyret P, et al., 2011, Extra-articular techniques in anterior cruciate ligament reconstruction: a literature review.
Newman S, Gupte C, Horwitz M, 2011, Minerva, BMJ, Vol: 343, ISSN: 0959-8138
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Atrey A, Gupte CM, Corbett SA, 2010, Review of successful litigation against english health trusts in the treatment of adults with orthopaedic pathology: clinical governance lessons learned., Journal of Bone and Joint Surgery-American Volume
Stanton JES, Gupte CM, Mahadevan V, 2010, (ii) Surgical approaches to the knee joint, Orthopaedics and Trauma, Vol: 24, Pages: 92-99, ISSN: 1877-1327
There are various surgical approaches to the knee joint and its surrounding structures, and such approaches are generally designed to allow the best access to an area of pathology whilst safeguarding important surrounding structures. In this article we provide a concise account of the commonly used approaches to the knee joint. Many knee procedures nowadays are routinely performed via arthroscopic or arthroscopic assisted methods. However, knowledge of open surgical access to the knee remains vital for knee arthroplasty surgery and cases where arthroscopy is not possible or practical. Crown Copyright © 2010.
Gupte C, Gupte CM, Bull AMJ, et al., 2010, Meniscofemoral ligaments: MRI and arthroscopy correlation., Radiological Society of North America
Gupte CM, Bayona S, Bello F, et al., 2010, A virtual reality arthroscopy simulator: face and construct validity, British Orthopaedic Association Annual Congress
Stanton J, Gupte CM, Mahadevan V, 2010, Surgical approaches to the knee, Orthopaedics and Trauma, Pages: 92-99
Atrey A, Gibb P, Gupte CM, 2010, Assessing and improving the knowledge of orthopaedic foundation-year doctors., The Clinical Teacher
Jaggard MKJ, Gupte CM, Gulati V, et al., 2009, A comprehensive review of trauma and disruption to the sternoclavicular joint with the proposal of a new classification system., The Journal of trauma, Vol: 66, Pages: 576-584
BACKGROUND: The sternoclavicular joint (SCJ) is rarely injured but should not be overlooked in cases of high-energy trauma. Stability is reliant on the ligamentous attachments. The methods of injury and the clinical presentations are examined. Obtaining informative plain radiology of the SCJ is challenging and the best methods to achieve this are discussed. METHODS: The Pubmed and Medline databases were searched for all literature relating to the keywords of "sternoclavicular" or "SCJ." CONCLUSIONS: Early closed reduction in acute injury is advisable. Complications of posterior dislocation to the SCJ are potentially severe and occasionally life threatening. Long-term stability is often difficult to achieve and can be significantly debilitating. Operative methods to restore joint stability are examined and the evidence to support them is presented. We propose a simple classification system to aid in making management decisions.
Jaggard M, Gupte CM, Gulati V, 2009, A comprehensive review of trauma and disruption to the sternoclavicular joint with the proposal of a new classification system. J Trauma. 66(2):576-84.
Atkinson HDE, Hamid I, Gupte CM, et al., 2008, Postoperative fall after the use of the 3-in-1 femoral nerve block for knee surgery: a report of four cases., J Orthop Surg (Hong Kong), Vol: 16, Pages: 381-384, ISSN: 1022-5536
We present a serious postoperative complication related to the use of femoral nerve block in 4 patients, each of whom fell and sustained further injury. Preoperatively, all patients underwent a 3-in-1 femoral nerve block with 30 to 35 ml of 0.25% levobupivacaine with 1:200,000 epinephrine, with guidance by a nerve stimulator. After the falls, neurological examination of the operated legs revealed reduced 2-point discrimination, pain, and/or light touch sensation. All patients underwent further operation for the fall injury and had delayed full weight bearing. We recommend that, after having a femoral nerve block, patients should undergo enhanced postoperative evaluation of blockade and proprioceptive function to ensure safe neurological function before mobilisation.
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