JTO - March 2021

03 Mar 2021

Volume 9 Issue 1

From the Executive Editor

So the New Year certainly started with a bang... not due to the fireworks that had all been cancelled but courtesy of the ‘New Variant’ of an ‘Old Foe’. We were straight back into the thick of things and recovery is only just starting but there are some green shoots of spring appearing and reasons to be cheerful.

And what do you do when the nights are still long and work is not quite what you would like it to be… perhaps relax, put your feet up, curl up on the sofa and peruse a magazine or indeed the JTO? Well, I think you should... this edition is a pot pourri of interesting bits and pieces for you to dip in and out of. Like any good magazine, this edition of the JTO has a travel section where we will take you abroad (something we are all sadly missing) to Malawi, and a reflection by John Cashman on what has been achieved there during his tenure and beyond (page 36). Reflecting is a little bit of a theme this issue with Andrea Sott writing about her experiences not only, of rising to the challenges of a Medical Director post but in COVID-19 times too and the knock on effects of the ‘casual comment’ both good and bad (page 24). However, if its reflection you are after, look no further than the excellent article by Alister Hart looking at Ronnie Furlong the man and his hip (page 20) and going even further back, Ian Stephen our BOA Archivist, reflects on the origins or our Association (page 18). Looking at that menu and the signatures on it, always gives me a slight shiver down my spine.

 

We can’t spend all our time in the past though so the challenges of being a trainee and where you are going to be trained is a constant concern at present – but hopefully the words by Ran Wei and Rob Gregory will be reassuring. I will take this opportunity to remind you that the new curriculum starts in six months time and trainers as well as trainees must be ready – this will involve you learning new things!

I know orthopods and there is only so much relaxing we can take so, of course, this JTO covers research and academia too – particularly clinically relevant research via our research champions and Hunterian Professors. Andrew Price and colleagues would like us to remember ‘it’s all about the knee’ – the soft tissues anyway, if not the joint! I think it’s all about the kids – but perhaps that will be for a future edition!

2020-21 has seen us embrace ‘alternative’ media, so if reading the JTO cover to cover is more than your attention span can cope with, I suggest you have a look at the Transient Journal webpages (www.boa.ac.uk/T-JTO) where you will find podcasts on knitting and pieces on constructing dinosaurs; perhaps they are vying for inclusion in the indicative procedures section of our new curriculum? Or maybe not… maybe it’s just for fun and happiness and we are all in favour of that at the moment.

As we head into Spring, and the future looks brighter please remember – “Great opportunities to help others seldom come, but small ones surround us every day.”– Sally Koch

I hope you enjoy this JTO and if you have any ideas for future articles, please let me know.

Deborah Eastwood, Vice President Elect

 

Subspecialty Section

 

References

Society for Back Pain Research (SBPR) update

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  2. Binch A, Snuggs J, Le Maitre CL. Immunohistochemical analysis of protein expression in formalin fixed paraffin embedded human intervertebral disc tissues. JOR Spine. 2020;3(3):e1098.
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The posterior malleolar fracture – is the rule of a third or use of percentages an orthopaedic myth?

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  10. Sheikh HQ, Mills EJ, McGregor-Riley JC, Chadwick C, Davies MB. The effect of computerised tomography on operative planning in posterior malleolus ankle fractures. Foot Ankle Surg. 2020;26(6):676-80.
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  12. Meijer DT, Doornberg JN, Sierevelt IN, Mallee WH, van Dijk CN, Kerkhoffs GM, et al. Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury. 2015;46(10):2024-9.
  13. Buchler L, Tannast M, Bonel HM, Weber M. Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma. 2009;23(3):208-12.
  14. Kumar A, Mishra P, Tandon A, Arora R, Chadha M. Effect of CT on Management Plan in Malleolar Ankle Fractures. Foot Ankle Int. 2018;39(1):59-66.
  15. Haraguchi N, Haruyama H, Toga H, Kato F. Pathoanatomy of Posterior Malleolar Fractures of the Ankle. J Bone  Joint Surg Am. 2006;88(5):1085-92.
  16. Mason LW, Marlow WJ, Widnall J, Molloy AP. Pathoanatomy and Associated Injuries of Posterior Malleolus Fracture of the Ankle. Foot Ankle Int. 2017;38(11):1229-35.
  17. Lambert LA, Falconer L, Mason L. Ankle stability in ankle fracture. J Clin Orthop Trauma. 2020;11(3):375-9.
  18. Haraguchi N, Armiger RS. Mechanism of posterior malleolar fracture of the ankle: A cadaveric study. OTA International. 2020;3(2):e060.
  19. Gardner MJ, Brodsky A, Briggs SM, Lorich DG, Nielson JH. Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Rel Res. 2006(447):165-71.
  20. Baumbach SF, Herterich V, Damblemont A, Hieber F, Böcker W, Polzer H. Open reduction and internal fixation of the posterior malleolus fragment frequently restores syndesmotic stability. Injury. 2019;50(2):564-70.
  21. Miller MA, McDonald TC, Graves ML, Spitler CA, Russell GV, Jones LC, et al. Stability of the Syndesmosis After Posterior Malleolar Fracture Fixation. Foot Ankle Int. 2018;39(1):99-104.
  22. Fitzpatrick E, Goetz JE, Sittapairoj T, Hosuru Siddappa V, Femino JE, Phisitkul P. Effect of Posterior Malleolus Fracture on Syndesmotic Reduction: A Cadaveric Study. J Bone Joint Surg Am. 2018;100(3):243-8.
  23. Jayatilaka MLT, Philpott MDG, Fisher A, Fisher L, Molloy A, Mason L. Anatomy of the Insertion of the Posterior Inferior Tibiofibular Ligament and the Posterior Malleolar Fracture. Foot Ankle Int. 2019;40(11):1319-24.
  24. Odak S, Ahluwalia R, Unnikrishnan P, Hennessy M, Platt S. Management of Posterior Malleolar Fractures: A Systematic Review. J Foot Ankle Surg. 2016;55(1):140-5.
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The anatomy of an awesome randomised trial

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  5. Beard DJ, Davies LJ, Cook JA, et al. The clinical and cost-effectiveness of total versus partial knee replacement in patients with medial compartment osteoarthritis (TOPKAT): 5-year outcomes of a randomised controlled trial. Lancet. 2019;394(10200):746-56.
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Surgical rationing in times of COVID-19 pandemic – how does it affect the Montgomery ruling and GMC guidance on consent?

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Arthroscopic menisectomy for isolated meniscal tears – changing practice

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  2. Khan KM. Deimplementing arthroscopy, improving concussion reporting and celebrating research quality. Br J Sports Med. 2020;54:1305-1306.
  3. Abram SGF, Beard DJ, Hing CB, Price AJ. Evidence update: A summary of new evidence to inform treatment decisions for patients with meniscal lesions. Knee. 2019;26(3):521-523.
  4. Abram SGF, Beard DJ, Price AJ. National consensus on the definition, investigation, and classification of meniscal lesions of the knee. Knee. 2018;25(5):834-840.
  5. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Kalske J, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: A 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020;54(22):1332-1339.
  6. Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: Randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740.
  7. Abram SGF, Hopewell S, Monk AP, Bayliss LE, Beard DJ, Price AJ. Arthroscopic partial meniscectomy for meniscal tears of the knee: A systematic review and meta-analysis. Br J Sports Med. 2020;54(11):652-663.
  8. Laprade RF, Spalding T, Murray IR, Chahla J, Safran MR, Larson CM, et al. Knee arthroscopy: Evidence for a targeted approach. Br J Sports Med. 2020. [Epub ahead of print].
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Is ACL repair possible?

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  2. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term follow up of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med. 1991;19(3):243-55.
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  4. Ateschrang A, Schreiner AJ, Ahmad SS, Schröter S, Hirschmann MT, Körner D, et al. Improved results of ACL primary repair in one-part tears with intact synovial coverage. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):37-43.
  5. Getgood AMJ, Bryant DM, Litchfield R, Heard M, McCormack RG, Rezansoff A, et al. Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020;48(2):285-97.
  6. Difelice G, Villegas C, Taylor S. Anterior Cruciate Ligament Preservation: Early Results of a Novel Arthroscopic Technique for Suture Anchor Primary Anterior Cruciate Ligament Repair. Arthrosc J Arthrosc Relat Surg. 2015;31:2162-71.
  7. Mackay G, Anthony IC, Jenkins PJ, Blyth M. Anterior Cruciate Ligament Repair Revisited. Preliminary Results of Primary Repair with Internal Brace Ligament Augmentation: A Case Series. Orthop Muscular Syst. 2015;4(2):188.
  8. Murray MM, Fleming BC, Badger GJ, BEAR Trial Team, Freiberger C, Henderson R, et al. Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial. Am J Sports Med. 2020;48(6):1305-15.
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