On The Podium by OrthoSpaceX

Physeal-Sparing MPFL Reconstruction in Adolescents. Dr. Nayef Aslam-Pervez

Mon, 30 Mar 2026 16:59:12 GMT

Physeal-Sparing MPFL Reconstruction in Adolescents

An Interview with:

Dr. Nayef Aslam-Pervez

Issue 20, April 2026

About Dr. Nayef Aslam-Pervez

Mr. Aslam-Pervez is a distinguished Consultant Orthopaedic Surgeon based in Yorkshire. He works at a major trauma centre and tertiary referral hospital, treating highly complex cases

with excellent outcomes.

The Knee Research Unit (KRUH) at Hull

University Teaching Hospitals was established to lead and coordinate knee-related research within the Trust and as part of a regional MDT across Yorkshire. The unit is involved in multiple research projects, including the paediatric synthetic MPFL reconstruction study, with ongoing follow-up and further research being conducted under the umbrella

of the KRUH.

As the Lead for Soft Tissue Knee Surgery and previously Clinical Governance Lead in both Hull and London, Mr. Aslam-Pervez has extensive experience in building and

maintaining the highest quality of orthopaedic services. His practice combines advanced surgical

techniques with comprehensive patient care to deliver excellent outcomes, with a special interest in sports injuries and joint replacement surgery.

We would like to thank Dr. Nayef Aslam-Pervez for his insight.

Thank you for being part of Our Community

We believe in pushing boundaries, sharing knowledge, and highlighting the people and ideas shaping the future of orthopaedics. On the Podium is our platform for showcasing the journeys, challenges, and breakthroughs of those making a positive impact in the orthopaedic community.

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

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When Bone Meets Byte: Exploring AI’s Role in Modern Orthopaedics. Professor Mohamed Imam

Wed, 19 Nov 2025 21:10:25 GMT

When Bone Meets Byte:

Exploring AI’s Role in Modern Orthopaedics

An Interview with:

Professor Mohamed Imam

Issue 19, November 2025

Professor Mohamed Imam is an exceptionally skilled consultant orthopaedic surgeon who specialises in upper limb surgery, sports injuries, and complex trauma.

Professor Imam uses the latest technology in diagnosing a wide range of upper limb conditions. He has gained leading expertise in the diagnosis and management of wrist, shoulder, hand and elbow conditions, and is highly skilled in the treatment of sports injuries. Among his repertoire of procedures are major shoulder tendon repair, upper body tendon tears, joint preservation, joint replacement, cartilage regeneration, and reconstruction surgery.

Furthermore, Professor Imam specialises in arthroscopic (keyhole) surgery to treat numerous conditions, including arthritis, tennis elbow (lateral epicondylitis), rotator cuff tears, frozen shoulder and tendonitis, as well as wrist and hand conditions such as Dupuytren's contracture and cubital tunnel syndrome.

His extensive specialist training took place in the UK and internationally. In fact, he has been awarded multiple awards and international travelling fellowships, including a fellowship with Professor Christian Gerber, the world-leading pioneer of modern shoulder surgery, at Der Balgrist University Orthopaedic Centre of excellence in Zurich, Switzerland. What's more, he undertook travelling fellowships to gain up-to-date international experiences in Mayo Clinic, The Steadman clinic (the US Olympic team centre of excellence) and Stanford University.

Research is another area of Professor Imam's career. He is the chief investigator of leading national and international studies. His work is widely recognised, and he has published more than 150 peer-reviewed publications in top international medical journals and written more than 40 textbook chapters on upper limb injuries.

Professor Imam has accomplished many achievements throughout his career. He has designed orthopaedic instruments, designed and published different techniques, and authored two books. One of these books surrounding the theme of the use of stem cells in orthopaedics and another concerning shoulder arthroscopy. He regularly presents his research at various national and international meetings. Currently, Professor Imam, with an elite team of researchers, is investigating the use of artificial and machine intelligence in surgery.

We would like to thank Professor Mohamed Imam for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

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Complex Elbow Trauma with Mr. Sam Vollans

Fri, 24 Oct 2025 16:21:07 GMT

Complex Elbow Trauma

An Interview with:

Mr. Sam Vollans

Issue 19, Epirsode 2, October 2025

We would like to thank Mr. Vollans for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

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How a Soccer Injury Sparked a Career in Sports Surgery - Dr. Loiy Alkhatib

Sat, 13 Sep 2025 08:34:21 GMT

How a Soccer Injury Sparked a Career in Sports Surgery

An Interview with:

Dr. Loiy Alkhatib

Issue 18, October 2025

Dr. Alkhatib graduated from Jordan University of Science and Technology (JUST) and George Washington University Hospital (GWUH) in 2009.

He completed his training in Orthopedic and Trauma Surgery in Germany and was awarded the German Board of Orthopedics and Trauma Surgery (Facharzt). Mr.Alkhatib is a certified Orthopedic surgeon in the United Kingdom (UK), holding the GMC/reg. number (7260292), as well as ECFMG certificate (07247543).

Dr. Alkhatib completed an Upper Extremity Reconstruction and Sports Medicine Fellowship at University of Manitoba in Canada. Moreover, he completed an Orthopedic Trauma fellowship at the same university.

He completed a shoulder and elbow surgery fellowship at University College of London Hospital (UCLH). He was a visiting physician at Shoulder and Elbow Surgery Unit at Holy Cross Hospital in Florida, and at Sports Medicine Surgery Clinic at NY-Langone (Hospital for Joint Diseases) in New York,USA. he completed an AIOD Trauma/Upper limb Reconstruction Fellowship in Edinburgh, Scotland.

He also completed an AO Trauma Fellowship at Coventry University Hospital, second largest trauma center in UK. Alkhatib was appointed as an Orthopedic and Trauma Surgery Consultant at Klinikum Bad Hersfeld, and St.Marianen Hospital in Germany. Currently, he is working as Orthopedic surgeon and sports medicine consultant at Dr.Suleiman AlHabib Hospital, Dubai.

The scope of his work includes evidence-based treatment of upper limb trauma, sports injuries and degenerative conditions of the upper and lower limbs.

Dr. Alkhatib has an interest in postgraduate education and has been selected to participate as an instructor in AO Trauma courses, as well as courses held by Arthrex for Shoulder and Elbow, and knee reconstruction. In his spare time Alkhatib enjoys travelling and karting.

We would like to thank Dr. Loiy Alkhatib for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

Thank you to our sponsors:

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Making Medical Conferences Run Like Clockwork. An Interview with: — David Penford —

Thu, 21 Aug 2025 16:58:09 GMT

Making Medical Conferences Run Like Clockwork

An Interview with:

— David Penford —

Issue 17, August 2025

We would like to thank David penford for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

Thank you to our sponsors:

To download this issue of On The Podium , click below.

From Pitch to Recovery Evolving Sports Medicine for Athletes and Active Lifestyles — Mr. Neil Jain —

Sun, 01 Jun 2025 13:58:03 GMT

From Pitch to Recovery

Evolving Sports Medicine for Athletes and Active Lifestyles

— Mr. Neil Jain —

Issue 16, June 2025

We would like to thank Mr. Neil Jain for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

Thank you to our sponsors:

To download this issue of On The Podium , click below.

Copy of From Pitch to Recovery: Evolving Sports Medicine for Athletes and Active Lifestyles. — Mr. Neil Jain & Dr. Assaf Moriah —

Wed, 21 May 2025 10:08:25 GMT

From Pitch to Recovery:

Evolving Sports Medicine for Athletes and Active Lifestyles

— Mr. Neil Jain & Dr. Assaf Moriah —

Issue 15, May 2025

Watch the below edition of On The Podium stories where we sit down with Mr. Neil Jain and Dr. Assaf Moriah to discuss evolving sports medicine for athletes, active lifestyles, treating elite athletes and managing expectations.

We would like to thank Mr. Neil Jain and Dr. Assaf Moriah for their insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

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The Inventive Mind: A Journey of Innovation, Discovery, and Synthetic Ligament Breakthrough. — Dr. Bahaa Seedhom —

Sat, 26 Apr 2025 15:57:48 GMT

The Inventive Mind:

A Journey of Innovation, Discovery, and Synthetic Ligament Breakthrough

— Dr. Bahaa Seedhom —

Issue 14, May 2025

What early experiences in your life ignited your passion for medical innovation and led you to explore the development of synthetic ligaments?

All I can say about my early experience is that when I was a kid, I wanted to be a medic. But my good father coerced me to get into engineering, and while consenting grudgingly I did well in my first degree. Subsequently I did a PhD in textiles engineering at Leeds University, after which I still hankered after being a medic! This hunger found its satisfaction when I Joined the bioengineering group that has been formed two years earlier. That group, a consortium of engineers and medics, was led by two professors one from the Department of mechanical engineering, Professor Duncan Dowson. And, Professor Verna Wright, head of the other department, the Rheumatism Research Unit, Leeds Medical school.

Looking back at your collaboration with Dr. Kyosuke Fujikawa, what was it about your partnership that allowed you to push boundaries and develop the textile-based implant for the ACL?

Dr Kyosuke Fujikawa, a Japanese orthopaedic surgeon from Keio University, did his MPhil degree with me at the Unit. During his stay we discussed the possibility of using polyester yarn for developing an artificial meniscus. He suggested, “why don't we start with something simpler like the ACL”? And this is where it all started, and it was very serendipitous. But I must confess that I had to learn about the ACL as then I knew nothing about its function or of the significance of its injury. Before Kyosuke returned to Japan, we did some preliminary experiment on a pig's knee in the lab, and then on five living pigs. Promising data from the pig experiment encouraged Kyosuke to start reconstructing the ACLs in his patients with some of the implant material that he took with him. The first case, I think, was around February 1981 or 1982.

Can you describe the biggest challenges you faced in the early stages of developing synthetic ligaments, and how you overcame them?

The biggest challenge was finding a company to take on that device, to manufacture and to commercialize it. Then, I was so naive, and so surprised that those we approached were totally uninterested and dismissive. Now I understand why.

However, thanks to my boss, Verna Wright, who gave me his staunch support to found a company to manufacture and commercialize the device.

How do the biomechanics of synthetic ligaments differ from those of natural ligaments, and how did you address these differences?

Probably we're referring to the mechanical properties, namely strength and stiffness. The natural tissues’ properties vary between individuals. The length of a natural tissue graft does also vary. The variations in dimensions and strength can render them unreliable. By contrast with synthetic ligaments, you have consistency; surgeons get exactly what they expect when they open a package. However, I must point out that synthetic ligaments are stiffer, or less stretchy under the same loads than natural ligaments.

What specific structural features have been included to ensure the long term durability of the implant under repeated mechanical stress?

Material choice was a matter of foremost importance. It had to be safe and known to be acceptable to the body. It had to possess mechanical properties that enabled constructing devices with close properties to the natural tissues. But one distinct feature of our devices is its basic loose weave, which allows them to be efficiently colonized by tissue. Of course this is a natural body process. But, if you want a device to be colonized with tissue that can either increase its strength or protect it from abrasion, you must have it designed with sufficient space for tissue to grow into. So, the structure, the loose structure is a distinct feature of our devices.

What has been the most rewarding aspect of seeing your synthetic ligaments being used to treat patients worldwide?

It's precisely what you just said, seeing our devices used successfully in patients worldwide is a most rewarding experience. I hope this is the same for my colleagues, and for the surgeons using our products.

How did your background and upbringing influence your decision to focus on a field as specialised and challenging as orthopaedic implants?

It might have been the stubborn streak passed on in the genes I inherited from my father, Mr Botros Seedhom.

What key attributes do you look for when selecting leaders within Xiros, and how do these attributes contribute to the company's success?

A leader must have appropriate qualifications, by this is meant the required knowledge to perform their role efficiently. Leaders must be persons of unquestionable integrity. Then, they must have convincing track records. Compromising on any of these requirements would be courting disaster for the future of any company.

What is the legacy you hope to leave behind, both in terms of the innovations you’ve created and the culture you’ve cultivated at Xiros?

Thank you for this question. A major legacy I hope to leave is the company itself and its people, with its particular ethos, especially in the tough field of medical products. Xiros is a people's company and tries to operate with integrity and to cultivate mutual loyalty with its people. This is evidenced by the number of people who have stayed with us for periods in excess of two decades. Another legacy is the useful products and their impact on people's lives. Equally important is the culture behind developing these products with uncompromising quality. One such product was developed some 26 years ago. Of this we have manufactured around 3.7 million units. We hope that each one of these made a positive impact on the recipient’s.

What are the moments or achievements in your career that bring you the most fulfilment, and why?

The first time to witness a case in which a surgeon used one of our devices in a patient was a very special and exciting moment. Always full of emotions, those of relief and satisfaction after much challenging work on part of the team, and also of hope mixed with anxiety; will it be successful?

What advice would you give to young innovators who aspire to make a difference in the medical field, particularly those who wish to follow in your footsteps?

My advice is that they when developing implant devices, they should not work in isolation but collaborate with groups, not single individuals. These groups should comprise the device’s prospective users (e.g. surgeons), potential manufacturers, and colleagues in the quality and regulatory teams. Most important is that they should practice exchanging knowledge with their collaborators. They must never compromise their scientific integrity and follow the scientific principles they have learned. But they should do so while maintaining humility and deference to all colleagues participating in a project.

We would like to thank Dr. Bahaa Seedhom for his insight.

Thank you for being part of Our Community

Your engagement helps us continue to bring important stories to light and grow a community of forward thinkers.

Thank you for reading, supporting, and being part of this journey. We look forward to exploring more with you.

Thank you to our sponsors:

To download this issue of On The Podium , click below.

Advancements In Knee surgery and Sports Medicine Expert Insights with: — Mr. Sanjeev Anand —

Mon, 24 Mar 2025 16:40:30 GMT

Advancements In Knee surgery and Sports Medicine

Expert Insights with:

— Mr. Sanjeev Anand —

Issue 13, March 2025

You regularly manage complex knee cases referred from other hospitals. What are some of the most challenging cases you have encountered, and how did you approach them?

In my practice, I often receive challenging cases referred from neighbouring hospitals and colleagues, which may be trauma-related, requiring urgent intervention, or complex elective pathologies requiring significant planning. Each of these cases is unique, and a standardised approach cannot be applied. Beyond the clinical challenges related to surgical management, which are often within my control, there are significant logistical challenges in organising the necessary resources to provide appropriate treatment in a timely manner. At Leeds Major Trauma Centre, we receive referrals for significant and complex knee injuries, often involving associated damage to the nerves and blood vessels, which can affect the viability of the limb. A multidisciplinary approach involving vascular surgeons and plastic surgeons is frequently required. A knee surgeon dealing with such injuries must be well-versed in 360-degree knee joint reconstruction. A substantial part of my practice is dedicated to paediatric patients, who present their own unique challenges. Knee injuries in young patients not only impact their physical health but also their mental well-being and, by extension, the welfare of their entire family. Surgical instruments are often not designed for very small knees, requiring great care and skill to prevent injury to vital structures. In my elective practice at Chapel Allerton, we receive cases with previous multiple failed surgeries, complex deformities, or severe cartilage damage in young patients. These cases require detailed preoperative assessment, multidisciplinary discussions, and meticulous planning to determine the most appropriate intervention. Postoperative rehabilitation is crucial in restoring function for these patients.

Given your specialisation in paediatric knee injuries, what are the most common misconceptions parents have about knee injuries in children?

One of the most common misconceptions is that any knee pain in a child is simply growing pains. While this is true in some cases, persistent discomfort that restricts daily activities, particularly when accompanied by joint swelling or mechanical symptoms such as locking or catching, should not be ignored. I frequently see cases where long-standing knee problems, initially dismissed as growing pains, turn out to be conditions such as osteochondritis dissecans, which require early management to prevent joint surface damage. Another common misconception is that children do not sustain serious knee injuries due to their developing musculoskeletal system. However, paediatric ACL injuries, osteochondral defects, and meniscal tears are increasingly recognised, especially in young athletes involved in high-impact sports. There is also a belief that surgery should always be delayed until skeletal maturity. While it is essential to preserve growth plates, delaying necessary surgical intervention in cases of complete ligament ruptures or unstable meniscal tears can lead to further joint damage, increasing the risk of early osteoarthritis. Additionally, some parents underestimate the importance of structured rehabilitation, assuming surgery alone will resolve the issue. In reality, a well-planned postoperative rehabilitation programme is key to a successful recovery. At other times, parents are naturally concerned about transient injuries restricting a child's physical abilities. As a surgeon, my role is to rule out serious conditions, provide reassurance, and identify issues that may benefit from early intervention to optimise function.

How do the knee problems you encounter in adolescents differ from those seen in adults, and how does this influence your treatment approach?

Knee conditions in adolescents differ from those in adults primarily due to skeletal immaturity, the presence of open growth plates, and the unique biomechanical demands of growing athletes. Unlike adults, adolescents are prone to specific injuries such as tibial spine avulsions (instead of ACL ruptures), osteochondritis dissecans, and patellar instability due to increased ligamentous laxity. Growth plate involvement necessitates specialised surgical techniques that avoid physeal damage, reducing the risk of growth disturbances. In contrast to adult knee injuries, which are often degenerative, adolescent knee injuries are frequently acute and sports-related. Treatment approaches must consider both short-term recovery and long-term joint preservation. Whenever possible, meniscal preservation is prioritised, and ACL reconstruction techniques are tailored to protect the growth plate. Young athletes are at a high risk of reinjury, so treatment strategies must aim to mitigate this risk. Another common injury pattern in sporty adolescents is repetitive stress injuries. As their skeletons mature, certain zones of weakness remain, where repetitive muscle loading can cause conditions such as Osgood-Schlatter disease or Sinding-Larsen-Johansson syndrome. It is crucial to manage activity levels in these children, as excessive demands on their growing skeletons increase their risk of injury. However, restricting them from sports can also impact their mental health. Conditions such as anterior knee pain are particularly common in adolescent girls and can significantly affect their function and psychological well-being. A holistic management approach is essential to support them through this phase while maintaining function and improving pain management.

What are the key indicators that suggest a young athlete may require surgical intervention rather than conservative treatment for a knee injury?

The decision to proceed with surgical intervention in a young athlete is based on several key indicators. These include:

Persistent symptoms despite appropriate rehabilitation
High-grade ligamentous injuries (such as complete ACL or PCL ruptures)
Significant meniscal tears unlikely to heal without surgical repair
Osteochondral injuries with loose body formation
Recurrent episodes of joint locking or instability

Additionally, patient-specific factors such as sport-specific demands, skeletal maturity, and long-term joint preservation are critical considerations. In some cases, proactive surgery is necessary to preserve joint health, while in others, delaying surgery until skeletal maturity may be appropriate. A common injury in this age group is an anterior cruciate ligament (ACL) tear. An intact ACL is crucial not only for returning to sport but also for preventing further meniscal damage, which is vital for the long-term health of the knee joint.

Mr. Anand and team at Chapel Allerton Hospital

Could you share insights on how the field of paediatric knee surgery has evolved over the last decade?

Over the past decade, paediatric knee surgery has advanced significantly. Access to improved imaging modalities, particularly MRI, have enhanced diagnostic precision, allowing for early and accurate identification of injuries. Surgical techniques have also evolved, with a greater emphasis on reconstruction methods that preserve the native growth plate in skeletally immature patients. There is also increased awareness of meniscal preservation, with a shift towards repair rather than resection to reduce the long-term risk of osteoarthritis. Rehabilitation protocols have become more individualised, promoting a safe return to play while minimising the risk of reinjury.

You’ve been involved in developing guidelines for ACL reconstructions. What are the current best practices, and how have these changed over time?

I was fortunate to be involved in developing the BOA/BASK/BOSTAA document on “Best Practice for the Management of Anterior Cruciate Ligament (ACL) Injuries.” We are currently in the process of updating this document. Current best practices for ACL reconstruction emphasise an individualised surgical approach, appropriate graft selection, and augmentation where necessary. The transition from transtibial techniques to anteromedial portal drilling has improved tunnel positioning, enhancing graft function and reducing failure rates. There has also been a move towards early surgical intervention in high-risk populations, such as young athletes engaged in pivoting sports, to prevent secondary meniscal or cartilage damage. Additionally, there is a greater understanding of associated pathologies that must be addressed to prevent ACL reconstruction failure. Rehabilitation has evolved, with a shift from time-based to criteria-based progression, ensuring safer return to play.

Mr. Anand teaching arthroscopy

Can you discuss your approach to managing multi-ligament knee injuries, particularly in high-performance athletes?

Management of multi-ligament knee injuries in high-performance athletes requires a systematic and individualised approach. Surgical timing is critical, with staged versus single-stage reconstruction decisions based on the severity of soft tissue injury and neurovascular involvement. Anatomical reconstruction of all injured ligaments, rather than non-anatomic repair, is preferred to optimise stability and function. Rehabilitation protocols are structured to restore neuromuscular control while preventing stiffness. Close collaboration with physiotherapists is essential to a safe and efficient return to competition. Though this is a rare injury, with our major trauma service, we do receive a good number of these patients and have been fortunate to develop expertise in their management. These are complex injuries and are best dealt with in specialist units with multidisciplinary input available.

What gaps do you currently see in research related to knee injuries in young athletes, and what areas would you like to explore further?

I was part of a working group which led on identifying the top 10 research priorities in first-time soft tissue knee injuries, in partnership with the James Lind Alliance. This document is important as it looks at research questions that are meaningful to patients. Appropriate timing and management strategies for soft tissue knee injuries remain a critical concern. There are several gaps in research surrounding knee injuries in young athletes. Firstly, long-term outcomes following paediatric ACL reconstruction, particularly regarding re-injury rates and post-traumatic osteoarthritis, require further study. Additionally, there is a need for improved understanding of optimal rehabilitation strategies to reduce failure rates. The role of biologics and tissue engineering in enhancing graft healing and meniscal repair outcomes is another promising area for future research. Finally, developing better injury prevention programs tailored to different sports and age groups remains a priority.

Given your role as a trainer for arthroscopy skills, what do you believe are the key skills new orthopaedic surgeons must master early in their careers?

Mastery of arthroscopy requires a combination of technical proficiency, spatial awareness, and decision-making skills. Early-career surgeons must develop strong hand-eye coordination and dexterity to handle instruments efficiently within a confined joint space. Understanding triangulation and portal placement is crucial for optimising visualisation. In addition, they should focus on performing diagnostic arthroscopy with precision before progressing to more complex procedures such as meniscal repair and ligament reconstruction. Simulation training and cadaveric workshops play a vital role in refining these skills before transitioning to live surgery. I was part of a group that ran an arthroscopy course at the Royal College of Surgeons of England for many years. Now, in my role as Education Secretary for BOSTAA, I help with organising cadaveric courses for the next generation of surgeons.

How do you integrate your clinical experiences into your teaching curriculum for orthopaedic trainees?

Integrating clinical experience into teaching involves a combination of case-based learning, hands-on surgical training, and structured mentorship. At Leeds, we have a long-running knee fellowship programme, training soft tissue knee surgeons for the future. To my fellows, I emphasise the importance of understanding patient-specific factors in surgical decision-making, reinforcing this through case discussions and intraoperative teaching. Additionally, I encourage trainees to engage in research projects that bridge clinical practice with evidence-based improvements. Regular assessment and feedback help trainees refine their skills and develop confidence in their surgical approach.

Mr. Anand teaching on a surgical skills course

As a founder member and Academic Chair of ISKSAA, what are your primary goals for the organisation in the coming years?

I have been involved with ISKSAA soon after its inception. My main role has been in delivering its fellowship programme besides working as editor for its journal. I have now given up my work for the journal but am still coordinating the fellowship programme. These fellowships help improve standards of care for our patients by exchanging best practices across countries. We have placed nearly 300 fellows in different centres across the world since 2013. The primary goals for ISKSAA in the coming years include expanding opportunities for international fellowships, fostering collaborative research in sports medicine, and enhancing access to high-quality education through digital platforms. We aim to strengthen partnerships with global orthopaedic societies to facilitate knowledge exchange. We are hosting Great North Debate (www.greatnorthdebate.com) in Leeds in June 2025, in partnership with ISKSAA. We have an excellent faculty and scientific programme and would love to see you all in Leeds.

What advice would you give to medical students or junior doctors considering a career in orthopaedic surgery, particularly in sports injuries?

For those considering a career in orthopaedic surgery, I recommend developing a strong foundation in anatomy, biomechanics, and clinical assessment early on. Exposure to sports injuries through observerships and research projects can provide valuable insights. Additionally, acquiring surgical skills through cadaveric courses and simulation training is beneficial. It is crucial to stay updated with emerging techniques and actively engage in mentorship programs to refine both technical and decision-making abilities.

How has international collaboration through platforms like ISKSAA influenced surgical techniques and knowledge exchange in your experience?

International collaboration has significantly enhanced the exchange of surgical techniques, research advancements, and best practices. Through ISKSAA, we have facilitated international fellowships that allow surgeons to gain exposure to diverse approaches and cutting-edge technologies. Collaborative research initiatives have also contributed to the refinement of surgical protocols, improving patient outcomes. The ability to share complex cases and discuss management strategies with experts worldwide has been invaluable in advancing orthopaedic sports medicine.

The value of these international collaborations is recognised by surgeons across the world. I was fortunate to be awarded BASK’s Presidential Medal in 2023 for my work in fostering these collaborations.

What future trends or innovations do you anticipate will reshape the field of orthopaedic sports medicine over the next decade?

Several innovations are likely to reshape orthopaedic sports medicine in the coming decade. Advances in biologic therapies, including stem cell-based treatments, may enhance tissue healing and regeneration. Robotics and artificial intelligence will further refine surgical precision and decision-making. Additionally, improved wearable technology and motion analysis systems will play a greater role in injury prevention and rehabilitation. Personalised medicine, including genetic profiling for injury risk stratification, may also become an integral part of athlete management.

About Mr. Sanjeev Anand

Mr Anand has a special interest in treating all aspects of knee problems from sports injuries to arthritic knees. As a surgeon practising at a tertiary referral centre, a major part of his practice involves managing complex problems referred from colleagues and neighbouring hospitals. He also regularly treats paediatric knee problems both in the NHS and in the private sector. He is a recognised expert in treating Anterior Cruciate ligament injuries and led a working group that wrote national guidelines on ACL reconstruction. He has extensive experience in dealing with complex knee injuries requiring the reconstruction of multiple injured structures in the knee joint. His surgical approach is to preserve joint surface and meniscus to maximise function. He was part of the group which developed national guidelines for arthroscopic knee surgery. If an arthritic joint cannot be preserved, he offers a range of knee replacement options using the latest techniques. He holds weekly acute knee injury clinics at Nuffield Health Leeds Hospital to ensure prompt and optimum treatment for often missed injuries. He also has extensive experience in hip arthroscopic surgery, to deal with selected groin pain conditions and trochanteric bursitis. Mr Anand trained in Orthopaedics in London, Manchester and Leeds. Upon completion of his UK orthopaedic training, he undertook Specialist Surgical Fellowship training in arthroplasty and sports injuries in Australia. He is a trainer for arthroscopy skills and regularly conducts workshops for orthopaedic trainees. He is a founding member and Executive Director of the International Society for Knowledge for Surgeons on Arthroscopy and Arthroplasty (ISKSAA) and is Executive editor of the Journal of Arthroscopy and Joint Surgery. In 2023, Mr Anand was awarded the British Association for Surgery of the Knee President’s medal. He currently holds the position of Academic Secretary to the British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA)." Find out more about Mr Sanjeev Anand, visit his website: kneeandsportsurgery.co.uk

We would like to thank Mr. Sanjeev Anand for his time and insight into orthopaedic excellence.

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The fight against Antimicrobial Resistance: A Global threat in Trauma and Orthopaedic surgery

Fri, 22 Nov 2024 11:34:30 GMT

The fight against Antimicrobial Resistance:

A Global threat in Trauma and Orthopaedic surgery

An interview with:

— Professor. Chris Arts —

Issue 12, November 2024

Can you tell us about your role as Professor of translational biomaterials at MUMC+ & TU/e?

Yes of course. I'm Professor of Translational Biomaterials at the Department of orthopaedic surgery at Maastricht University Medical Centre and at the research group for Orthopaedic Biomechanics at Eindhoven University of Technology. In addition I'm the project leader and principal investigator of the NWA DARTBAC consortium, where we collaborate with 26 partners to develop material technology to combat antimicrobial resistance and support infection treatment and prevention. I also act as project leader and principal investigator in a 14 partner Interreg project entitled Prosperos-II, where we develop personalised bioactive bone implants for patient functional recovery based on new workflows enabling statistical shape modelling, finite element modelling and in vitro and in vivo test models.

What is infection, and how does it present in Orthopaedics?

Orthopaedic infections are a group of infections that involve the musculoskeletal system, including bones, joints, and soft tissues. These infections can result from various causes, such as bacteria, viruses, or fungi, and can lead to complications like inflammation, pain, and impaired function. The incidence of infection in orthopaedic trauma patients is high, ranging from 5% to 10% depending on the location and severity of the injury, and the type of fracture. Infection in orthopaedic trauma patients is a common problem associated with significant financial and psychosocial costs, and increased morbidity.

How big is the problem of infection in orthopaedics

Depends on the country of course. Already in Europe, we observe distinct differences in infection incidence and recurrence rates. The Netherlands and Nordic countries that employ proper antibiotic stewardship, that restrict antibiotic prescriptions and also have a clean food and water supply are less impacted than southern European countries. For primary joint infection incidence it's about 1-2 percent, but after revision surgery most implant registries show that the incidence is creeping upward and also that the incidence of implant revision due to deep infection is increasing. In comparison to implants infection in high-energy trauma, open fractures or extensive spinal surgery its up to 55%

How do you see the limitations of antibiotics?

First of all they will become less effective due to antimicrobial resistance. Bacteria can and will adapt quickly to new environments and treatment therapies. In the short-term we can compensate for that by employing combination therapy, mixing antibiotics together or mixing antibiotics with known antimicrobial compounds such as silver or copper ions. In the long-term, new antibiotics are desperately needed, however big pharma companies are not invested in this partly because of the lack of return on investment and making a profit. The antibiotic development pipeline is underdeveloped at the moment. New reimbursement strategies or incentive schemes will help with that. Also, I firmly believe that repurposing medicine will yield new treatment options. Given these limitations, the DARTBAC project was started to develop material technologies to prevent bacterial attachment and biofilm formation on medical devices and in body tissues.

What drives your passion for infection and AMR?

First of all, I like to help patients. That is still my primary drive. Also, in infection prevention and treatment and also the development of new antimicrobial technologies and diagnostics, disciplines need to come together and I like working in a multidisciplinary setting. You can learn much from each other.

Can you tell us about DARTBAC?

DARTBAC is an interdisciplinary 26 partner consortium from academia, industry, health funds, Dutch Institute of Heath and the Environment (RIVM) and communication partners that focuses on antimicrobial resistance (AMR) awareness within the Netherlands and Europe and the development of new material technology and diagnostics for prevention and treatment of infectious diseases. In our development of material technologies we work on additive manufacturing for implant surface modification, bioactive peptides, bioactive coatings, bioactive glass bacteriophages,induction heating and radiopharmaceuticals. They all aim at preventing bacterial attachment and biofilm formation on medical devices and in body tissues and can be used in prevention or treatment and some in both applications. If successful the chance that an infection occurs is severely minimised. We collaborate in research and development but also open up research methodologies and biobanking facilities between partners. Slowly we are branching out our consortium and as a next step would like to extend the setup of our project to a new European DARTBAC structure. If successful we can save on short- and long-term healthcare costs and improve the population productivity. Also, our technologies can in time be applied worldwide. picture show some material developments within DARTBAC

Top row: Left: 3-D printed spikes that have penetrated a bacterium.

Middle: Pyramid-shaped triangles that can damage the cell wall of bacteria.

Right: Bioactive glass that can have a bacteriostatic and bactericidal effect due to changes in pH and osmolarity. Bottom row: Left: Hip prosthesis without warming.

Bottom Middle: Thermal camera image of warmed hip prosthesis.

Right: Microscope image of a 3-layer coating with Silver as an active antibacterial component.

How worried should we be about Antimicrobial resistance?

We should be very worried. Prediction models tell us about 10M deaths will be related to AMR by 2050 and personally I believe that this is an underprediction. The associated healthcare costs for infection prevention and treatment and for the loss of productivity will be massive. Specifically for the United States, the Centres for Disease Control and Prevention (CDC) estimated the annual cost of AMR to be $55 billion - $20 billion for healthcare costs and $35 billion for loss of productivity. It is apparent that increases in antibiotic resistant bacteria will result in an higher infection incidence across all surgical interventions. These antibiotic-resistant bacteria will in future also be harder to eradicate. A combined higher incidence of infection by more antibiotic-resistant bacteria can result in higher treatment failure rates and ultimately increased incidence of complications and the necessity of amputations. It seems unlikely that the low infection incidence in primary joint arthroplasty results can be maintained in the next decades also warranting more revision surgeries and high associated healthcare costs.

What are you hoping to achieve with DARTBAC?

For the general population, we would like to establish more information about the threat of AMR. It will not stop at the border. Even more problematic, we cannot fully stop its development, only minimise its impact. Research that we perform should lead to new material technology able to prevent or kill antimicrobial resistant bacteria. The development of new high-speed diagnostics is also essential. I hope to extend the DARTBAC community to an European level.

How do you see the long term solution?

Well material technology and better diagnostics will help in mitigating AMR but not fully. New antibiotics or replacement pharmaceuticals are also desperately needed. For current antibiotics maybe local administration instead of systemic should be executed more, were possible of course. Governments,subsidy providers and policymakers need to be aware of the timelines of antibiotic and material technology developments and time to market approval. The investments on AMR are not sufficient and severely need to be increased. This requires a global approach as was performed during COVID and we each have a role to play.

How can we learn more about DARTBAC?

Through our papers, social media channels and project website

LinkedIn

linkedin.com/company/dartbac/

Youtube

youtube.com/@nwadartbac

Project website

https://nwa-dartbac.eu

Professor. Chris Arts

Chris Arts is Professor of Translational Biomaterials at the TU/e research group Orthopaedic Biomechanics and at the Maastricht University Medical Centre where he together with Prof Tim Welting heads the Laboratory for Experimental Orthopaedics. His clinical research focuses on translational biomaterials for delayed bone healing, infection treatment and spine deformity correction. This entails both the mechanical and biological assessment of biomaterials safety and efficacy performance but also longitudinal metabolic changes in the body. Utilizing high-resolution imaging combined with computational modeling the incorporation, remodeling and resorption phase of the biomaterials with the host tissue can be assessed. Furthermore assessment of bone healing in clinical patients; and evaluation and implementation of 3-D printing materials science and technology is a focus area. At Eindhoven University of Technology the focus of Arts' research is in assessment of contribution to mechanical bone strength of biomaterials during incorporation, remodeling and resorption phase using image analysis and validation and Finite Element Analysis (FEA). He aims at building bridges on biomaterials between medicine, clinical imaging and materials engineering research.

Read more about Professor. Art's practice here

We would like to thank Professor. Art's for his time and insight into orthopaedic excellence.

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The Road to Consultancy: A fellowship Journey

Mon, 21 Oct 2024 17:04:29 GMT

The Road to Consultancy: A fellowship Journey

An interview with:

— Mr. Jimmy Ng —

Issue 11, October 2024

Where did your love and passion for orthopaedics begin?

I ruptured my ACL playing basketball when I was 18. It took a year to get a diagnosis and then have my ACL reconstructed. This was my first exposure to orthopaedics and specifically sports injuries. This passion and interest grew through my early training and later during various rotations. These early experiences helped shape my training and future career.

During your medical training, what experiences or mentors guided you toward focusing on knee surgery within orthopaedics?

During my orthopaedic training, I was attracted to knee surgery particularly soft tissue knee surgery due to the variety of procedures that can be performed and from my own personal experience of knee injury. I had exposure to soft tissue knee surgery early in my orthopaedic training and one of my early mentors was Mr Fazal Ali in Chesterfield. Fazal’s accolade as an educator is well recognised and I did my first ACL reconstruction with him as a junior registrar. He sparked my interest in knee surgery and supported me throughout my training to pursue a career in soft tissue knee surgery. I did most of my orthopaedic training in Nottingham on the East Midlands North rotation. I have always wanted to return to Nottingham and work here. My aspiration was to become a comprehensive soft tissue knee surgeon capable of addressing all soft tissue knee problems including multiligament injuries, knee preservation surgeries and patellofemoral surgeries. I also recognised that there is a need to develop and improve this service in Nottingham given that the young population we treat and the volume of high energy trauma that presents to our major trauma centre at QMC. Therefore, I planned my training and education to ensure I gained all the knowledge, experience and skills required to provide and develop this service through fellowships, courses, conferences and visiting fellowships.

Revision ACL, HTO, PLC reconstruction

You completed four 6-month fellowships. Can you describe how each of these fellowships contributed to your growth as a surgeon?

I am extremely fortunate to have undertaken these fellowships and learnt from some of the best surgeons and individuals. I have chosen to do these fellowships to gain specific skills in preparation for my consultant job. My first fellowship was in sports knee surgery at Derby with Mr Guido Geutjens and Mr Nav Bhangoo. Derby is a high volume partial knee replacement centre with a prestigious sports knee fellowship. I had just finished orthopaedic training, and this fellowship was vital for me to further develop my arthroscopic skills and gain significant operative experience in partial knee replacements. I subsequently did a trauma fellowship at John Radcliffe Hospital in Oxford. It was a busy fellowship with lots of operative experience. I worked with all the orthopaedic trauma consultants and learnt various surgical techniques and approaches in complex peri-articular fractures. The most valuable lesson I learnt was the importance of preparation and surgical planning. This becomes second nature when a surgeon becomes experienced in the routine procedures. However, surgical planning is vital, particularly for the complex or less routine cases as well as for the less experienced surgeon when learning to perform a procedure. I continue to emphasise the importance of this to my trainees and fellows. My 3rd fellowship was in Coventry with Mr Tim Spalding and Mr Pete Thompson. The unit performs the highest number of meniscal transplants in the UK and receives referrals from all over the country. In addition to further advancing my operative skills, I became proficient in assessing and managing complex soft tissue knee conditions with the aim of preserving their joints in young patients. This has prepared me well for a consultant job and I was fortunate enough to secure a consultant post in Nottingham at this time. Despite this, I was determined to go to Perth for my sports surgery fellowship with Mr Pete D’Alessandro. I wanted to further elevate my skills in knee preservation and sports knee surgery prior to starting my consultant post. This fellowship far exceeded my expectation in terms of surgical volume, complexity and support I received. I did more ACL, multiligament knee reconstructions and osteotomies than all my previous training combined. I had the opportunity to run my own clinic and theatre regularly with support from my mentors which helped my transition to a consultant significantly. The most valuable thing I have gained from all my fellowships is the relationship and network I have built with my fellowship mentors and all the different people I have worked with.

How did your fellowship experiences vary between institutions or countries, and what unique perspectives did you gain?

All my fellowship experiences were good and provided specific experiences that I needed. The fellowships also offered me unique insights into different philosophies, assessments, management and operative techniques for a given condition or problem. There is often more than one way of doing things and its extremely valuable to be able to see and learn the different methods. As I started my consultant practice, I was able to modify and apply some of those methods into my practice. In addition to that, having the experience of different methods has given me more skillsets in my toolbox allowing me to adapt to different problems and challenges. There are also structural, administrative and managerial differences between all the institutions I’ve worked in, including a completely different healthcare system in Australia. There are unique challenges in individual institutions and healthcare systems that require bespoke solutions.

What made you choose Australia as a destination for your final fellowship?

I chose to go to Australia, mainly because of the skills and experience I could gain from the fellowship. I was blessed that the fellowship is based in Perth, which has some of the most beautiful beaches in the world with lots to offer for a family with young children. I had also lived in Perth for 2 years when I was a teenager and still have some friends and family there, including my younger brother. Both my parents and in-laws live in Malaysia, which is a short flight away. The experience of living in a different country, traveling around Australia and re-connecting with family members who otherwise live far away from the UK has made this an unforgettable experience for us.

Turquoise Bay

How did you manage to balance your family life with the demands of your 4 fellowships including 6 months in Australia?

I’m very lucky to have an extremely supportive wife who is a neonatal trainee herself. She’s taken time off for maternity leave and has gone part time since we’ve had children. She’s also taken time off training when we were on my fellowship in Australia. It would not be possible without her support and sacrifice in putting her career on hold during my fellowships. I’m so proud that despite taking time away from her career multiple times, she’s now started her subspecialist neonatal training and due to start her PhD in due course. Having young children with both parents working as doctors is extremely tough. It takes a lot of organisation, planning, swapping on calls and arranging childcare. I do my best to not take additional work back home and try not to take on additional workload on weekends.

Rottnest Island

What advice would you give to others who are applying for fellowships, especially those considering international opportunities?

Fellowships are extremely important for surgeons to develop their skills prior to starting their consultant practice. I highly recommend doing an international fellowship as the professional and personal experience I have gained from my fellowship in Perth was invaluable. However, I recognise that this may not be possible due to various reasons. There are lots of good fellowships in the UK and aboard, each offering different training and experiences. I recommend speaking to consultants and other fellows about their fellowships and find one that is best suited for your training needs and personal circumstances. Get in contact with the fellowship programme early. Lots of good fellowships are booked up 2 years in advance. I’d also recommend organising a visit to the unit and meet the team. This shows commitment and allows the unit opportunity to know a little more about you. You can also find out about the unit and whether the fellowship is the right choice for you. It’s much better to know that the fellowship is not suitable for you on the visit rather than after you’ve started. Plan early but be prepared to change your plan! Planning for fellowships should begin as early as possible, often during early years of registrar training. Good fellowships are competitive, and I encourage early planning and portfolio development to put yourself in a strong position to succeed. Despite careful planning, sometimes plans need to change, just like doing an operation. Be prepared to change your plan whatever life throws at you. Finally, if you’re considering an international fellowship and have the opportunity to do one, I recommend you take it! Although going for an international fellowship seems daunting - the endless paperwork, medical registration and moving to a different country, they are all achievable. There’s also a support group on Facebook called ‘Fellowship Life Transplant Services’ where you can get really useful advice, find accommodation and meet other fellows.

As you began your role as a consultant in Nottingham, how did your training experiences help you handle the transition to consultant life?

My fellowships have thoroughly prepared me with the skills and knowledge required for my consultant job. Getting the experience in independent decision making and operating was really helpful in aiding my transition to being a consultant. Having worked in different hospitals and systems on 4 fellowships helped me to adapt to working differently. Although I have trained in Nottingham, coming back to work here as a consultant was a different experience. I’m very grateful to have an excellent team here in Nottingham who had to learn my methods very quickly. I’ve also had to make some changes to the way I do things to fit the system. The combined experience from 4 different fellowships definitely helped this aspect of my transition.

What are your future goals as an orthopaedic consultant?

My goal is to become an expert in complex soft tissue and knee preservation surgery and continue to develop this throughout my career. I also aim to develop our soft tissue knee unit into a reputable centre, providing the best evidence-based treatment. I’ve started a soft tissue knee fellowship in Nottingham, replicating the excellent experiences I’ve gained from my fellowships to ensure our fellows get the same excellent training I’ve received. As a unit, we are committed to research and my colleague, Tom Kurien runs several trials related to arthritis. We are expanding our research portfolio and have ongoing research / projects in soft tissue knee surgery focusing on multiligament knee, paediatric knee, acl and meniscal injuries. I believe that collaboration and working with others a key part in improving ourselves as surgeon. I have founded with East Midlands Knee Preservation Society with colleagues around the region to collaborate on ideas and run an annual meeting to network and exchange knowledge.

Multiligament reconstruction

Looking ahead, how do you think the field of orthopaedic surgery will evolve, and what role do you hope to play in advancing the speciality?

I believe that data and technology will drive the development of orthopaedic surgery in the future. We need data to support everything we do, to provide the best possible treatment in the most cost-effective way. We need data from large scale randomised controlled trials and real-world clinical data such as a registry. I’ve been looking forward to the launch of National Ligament Registry (NLR) in the UK which will hopefully be soon. As a unit, we are committed to research and contributing to a national registry. We are signed up to be one of the pilot sites for NLR. Data can also be used to develop pathway and streamline processes to make them more efficient and cost-effective. I also believe that we need to collect our own data so that we know our own results and make changes to our practice to achieve better outcome for our patients. We need to have better ways of collecting this data. It needs to be simple, automated, labour effective and cost effective. I think this hasn’t been recognised by most institutions and this needs to be one of the priorities in future investment. The advancement in technology has been fascinating. The use of robotics and artificial intelligence in orthopaedic surgery has gained popularity in recent years. However, more research is required to determine their clinical benefits. Our research team has a plan to undertake research on utilising AI in orthopaedic surgery and our arthroplasty unit will soon have access to a robot. We need to share our findings with the orthopaedic community with the aim of advancing our specialty.

Meniscal transplant

Mr. Jimmy NG

Mr Jimmy Ng is a Consultant Trauma and Soft Tissue Knee Surgeon based in Nottingham University Hospitals NHS Trust. Jimmy completed medical school in Nottingham and undertook his orthopaedic training in the East Midlands region. His interest in sports and having ACL reconstruction himself at the age of 18 has sparked his interest in sport injuries around the knee. This led him to pursue a career in this subspecialty. Jimmy undertook prestigious fellowships in the UK (Derby, Oxford and Coventry) and in Australia (Perth) where he gained significant experience in managing sports injuries around the knee and performing complex reconstruction surgery to allow people to return to sports/activity. He believes in joint preserving surgery whenever possible to avoid or delay the progression of osteoarthritis. He has also visited multiple leading surgeons in the field of knee surgery (Dr Freddie Fu, Dr Volker Musahl, Dr Kevin Stone and Dr Rob LaPrade) to further his skills and learn new techniques. Jimmy now has a busy soft tissue knee practice in Nottingham, offering simple arthroscopic procedures to complex ligament (often multiple ligaments) reconstructions and re-alignment (osteotomy) surgery. He offers an individualised approach in ACL reconstruction surgery, tailoring his graft selection to individual patients needs. He also performs partial and total knee replacement surgery when joint preservation is no longer possible. Jimmy has set up a fellowship programme in Nottingham, which has attracted senior trainees from the UK and around the world to come and train with him. He is also an educational lead for the orthopaedic training programme in the East Midlands and is actively involved in surgical training and teaching. He has founded and is currently the president of East Midlands Knee Preservation Society, with the aim to collaborate with colleagues around the region and to improve the overall of quality of knee surgery in the region. Despite being a busy clinician, he continues to be active in research and attends conferences regularly to stay up to date in order to provide the best treatment for his patients.

Surviving and Thriving: A story of Resilience, Facing Life’s Greatest Challenges, and Transforming Orthopaedic Education. — Mr. Rishi Dhir —

Sat, 17 Aug 2024 12:55:09 GMT

Surviving and Thriving: A story of Resilience, Facing Life’s Greatest Challenges, and Transforming Orthopaedic Education.

An interview with:

— Mr. Rishi Dhir —

Issue 10, August 2024

Can you share your journey of becoming an orthopaedic surgeon and what initially inspired you to specialise in this field?

I would probably describe myself as a reluctant surgeon and even doctor. I was the first medic in my family and if anything was leaning more towards the arts but the idea of doing something which combined problem solving, compassion and empathy led me down the medical path. Again, I initially wanted to specialise in neurology and even forensic psychiatry at one point! However, it was my time dealing with orthopaedic problems in my A and E attachments which led me towards the specialty. I really enjoyed the logical aspect of the speciality combined with the hands on practical experience and ability to drastically and rapidly improve a patient's quality of life. Through this initial attraction and working with great mentors in the specialty it led me to a career in orthopaedics and eventually to specialise in upper limb surgery. As someone who loves raquet sports and bouldering and has experienced his fair share of hand, shoulder and elbow injuries, I very quickly fell in love with this speciality and haven't really looked back.

Your training pathway was unconventional. Can you elaborate on what made it different and how it shaped your career?

I would definitely describe my training as unconventional! I was a very keen musician and singer and took a year out of medical school to study popular music vocals and production. I still love music as a way to unwind and sing professionally to this day. I also worked for the European Space Agency as an undergraduate having won three international competitions to launch the first student experiment on the International Space Station and initially pursued a career as an astronaut but at that time, they were not taking on board medics as mission specialists. Finally, I gained alot of experience during the Junior Doctor's Strike in 2016 representing doctors in the media including the BBC, SKY and ITV and this gave me the experience of public speaking and presenting which I really utilised as part of my teaching style later in life. I think all of these diverse experiences, rather than being a distraction have taught me a number of important transferrable skills such as professionalism, working to deadlines, teamworking and also meeting people from different walks of life which have helped me greatly in shaping me as the person and surgeon I am today.

What were some of the biggest challenges you faced during your training and how did you overcome them?

Maintaining self-belief despite ups and downs. I would definitely describe my training as a rollercoaster rather than a smooth ride but having great mentors and a supportive family network helped me to take on board any meaningful and helpful criticism and filter out what could be destructive.

Were there any key mentors or experiences during your early career that significantly influenced your approach to orthopaedic surgery?

Several and probably too many to name but a few who spring to mind are Antony Greer, my first mentor, who instilled in me the fun and passion in orthopaedics and not to give up; Puneet Monga, one of my latter trainers who I respected immensely for his empathy, technical skill. and as a real thinker and Swee Ang, who taught me to be a humanitarian and appreciate perspective in the context of the wider world and helping others. I would say though that all my mentors, whether good or bad have shaped my career in some way and I am very grateful for the time and support that they have given me.

What motivated you to start 'Lets Talk Dr', and how did you go about establishing it?

I've had a long-standing interest in teaching, even at school when I used to teach students from home and kept this up throughout my career as an undergraduate, lecturer, postgraduate anatomy demonstrator and in writing book chapters and teaching on multiple courses. I always felt that as doctors we sometimes struggle with oral examinations and the ability to articulate and also with some of the resources available which I felt myself as a trainee were often outdated or difficult to digest. From doing television interviews or even musical auditions, I realised that many of the principles I had learned through trial and error and making countless mistakes were applicable to an oral exam or interview and thus wanted to teach doctors to talk- hence the title 'Let's Talk Dr'!

I initially started Let's Talk Dr as a few scribbles on the back of an exercise pad whilst waiting for patients to arrive in theatre in the canteen at the Royal London Hospital. Above all, I had a vision and wanted to enact it at all costs in spite of any naysayers or lack of funds. I think that pig-headed stubbornness and belief in my idea led me to sell my house and use the profits to start the business. I never wanted to take any loans from any family members in case- for want of a better term - it all went belly up! That way at least I could take responsibility for it as my expensive mistake. Luckily, it went from strength to strength and I haven't looked back.

Can you talk about how personal adversities you've faced have built your resilience and helped you grow your business?

In 2020 whilst as a locum consultant and vying for a permanent job and having launched let's Talk Dr nationally and set up another offshoot for A level biology students, Let's Talk Biology, I felt that I was at my peak and had the world at my oyster. Unfortunately, during a teaching session online I felt a sudden severe pain and a few minutes later was on the floor and admitted to hospital with life threatening necrotising gallstone pancreatitis. From feeling on top of the world as if I could do no wrong, I was in two organ failure, saying goodbye to my family and close to death. My goals had gone from setting up international courses and becoming a consultant in my dream specialty to being able to eat, go to the toilet or walk to the end of the corridor. I was shattered, my body was broken, mentally I was broken and I had no control over my destiny which I found so disempowering and there were times I wanted it all to end.

I went through some very dark times particularly with no visitors during COVID and 11 life saving operations and it was undoubtedly the support of a close family, friends and colleagues plus the technological marvel of facetime that pulled me through! I always remember saying to the doctors looking after me that I felt like Batman in 'the dark Knight Rises' when his back is broken and he is lying in a deep hole. I couldn't see a way out but if i could just have a chink of light or good news - I would pull myself out.

As difficult as this story is to share, it definitely helped me for the better- it made me more empathetic and understanding- both as a surgeon, teacher and human being and above all taught me the importance of perspective - taking each day as it comes and appreciating every day of life and taking it as it comes. Rather than mourning some of the things I can no longer do or have, I am so appreciative of everything that I do have. I always used to joke that if I could give anyone in their middle age a life-threatening disease but they survive - it is the best therapy you can ever have. It also taught me the importance of faith, support and self belief and I have taken these lessons on not only at work but in all my business ventures.

Can you share a success story of a trainee who has benefited from your training service?

Teaching has been a real blessing as I have had the privilege of meeting students from different deaneries, countries, training and non-training - each with a different story and different challenges and they challenge me every day. One of my greatest success stories was a wonderful doctor diagnosed later in life with dyslexia who struggled greatly with the FRCS exam and it impacted not only on his career but his self-belief and mental state. Getting him through the exam and seeing him flourish as a consultant has given me such immense joy and also taught me a valuable lesson about having diverse resources for all cohorts of learners and being adaptable in my teaching methods and not having a simple- one size fits all.

What unique aspects does your training service offer that differentiate it from other orthopaedic training programmes?

It is completely bespoke and individualised to each student. As well as offering mentorship and ongoing support that no other courses or programmes offer, I use revolutionary bespoke resources including videos which simplify even the most complex of concepts. Perhaps the biggest USP is the focus on technique- an undervalued concept in training but one that is so dear to my heart. When I see the impact it has had on my trainees and their decision making not only in the exam but in day to day practice, it fills me with immense satisfaction.

How do you envision the future of orthopaedic surgery training evolving, and what role do you see Let's Talk Dr playing in that future?

I think orthopaedics is one of those specialties that is so exciting because it continues to evolve and embrace change. As treatments and patient demands evolve, so must training. COVID has opened the door to a. number of opportunities including hybrid courses and meetings and i run several of these. Having trained over a thousand registrars from deaneries all over the UK and Ireland and internationally, I believe that Let's Talk Dr in collaboration with others can play a leading role in bringing that change and evolving techniques in training and education to a global audience.

What challenges did you encounter while setting up and running Let's Talk Dr, and how did you address them?

Financially it was a big challenge as well as gaining credibility and support. I have managed to address this through hard work, desire and self-belief and have also had great support from family, friends, colleagues and sponsors and other educators who it has been so exciting to collaborate with.

What innovative approaches or new initiatives are you planning to introduce at Let's Talk Dr to keep it at the forefront of Medical education?

I'll keep some of those close to my chest but rest assured we will continue to push the bar. Already in the next year we have three international face to face courses that have been set up, have expanded the portfolio to MRCS, ST3 interview and consultant interview training (through our close partner MDI courses ( www.mdicourses.co.uk ) and have an exciting video series in collaboration with BOMSA (Let's Talk BOMSA) with medical students. I would love to embrace new technology in education and above all - enjoy every challenge. I believe with the combination of social media and technology - we are in a golden age of education - the future is bright and I can't wait to embrace it.

Dr. Rishi Dhir

Dr. Rishi Dhir is a consultant orthopaedic surgeon specialising in upper limb surgery at Princess Alexandra Hospital in Harlow. He completed his basic surgical training and higher orthopaedic training on the Royal London rotation at Whitechapel. After completing his training in October 2017, he joined Princess Alexandra Hospital.

Dr. Dhir has extensive experience and training in upper limb surgery. He underwent fellowships in shoulder, elbow, and hand surgery at renowned institutions such as Wrightington Hospital, Edinburgh, and Melbourne, Australia from 2017 to 2019. His expertise includes elective shoulder, elbow, and hand surgery, including arthroscopy and arthroplasty of the shoulder, soft tissue procedures of the elbow, and both soft tissue and bony procedures of the hand. He also has a keen interest in general trauma and sub-specialist upper limb trauma.

Apart from his clinical work, Dr. Dhir is passionate about education. He has significant experience in producing written and video resources and delivering courses. He is involved in teaching and mentoring students worldwide through his revolutionary international teaching platform called "Let's talk Dr” rated as the one of the top international educational orthopaedic platforms, training over a thousand students in the UK and Ireland, USA, Australia, South Africa, South East Asia and the Middle East with a 5* rating on Google. He has collaborated with other educators and continuously strives to enhance medical education. Recently, he obtained a Postgraduate Diploma (PGDIP) in medical education from Cambridge University. He also has a passion for research having won three international grants as an undergraduate and worked for the European Space Agency to launch the first ever student experiment in space in 2001-2004.

Dr. Rishi Dhir's dedication to providing specialised upper limb care, passion for education, and commitment to teaching make him a valuable asset to the field of orthopaedic surgery.

Read more about Dr. Dhir’s practice here

We would like to thank Dr. Rishi Dhir for his time and insight into orthopaedic excellence.

Thank you to our sponsor:

JRI Orthopaedics

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A Pioneer of wide awake hand surgery. An interview with: — Mr. Alistair Phillips —

Tue, 23 Apr 2024 09:33:18 GMT

A Pioneer of wide awake hand surgery

An interview with:

— Mr. Alistair Phillips —

Issue 09, April 2024

Can you share your experiences and insights from your fellowship training at the Pulvertaft Hand Centre in Derby?

The Pulvertaft hand centre in Derby is a world-renowned centre of excellence for hand surgery and I was most fortunate enough to be able to work there for my fellowship. The hand centre is separated from the main bulk of the hospital and it felt very much like it was a self-enclosed centre. When I worked there there were eight consultants and I believe there are now 10. It was mainly staffed by five fellows of which I was one and we were thoroughly well supported by the consultants on the shopfloor. Because it's a tertiary referral centre we saw the most amazing pathology and all the latest innovations, techniques and experience. I remember one occasion when an unfortunate gentleman had cut his hand off at the wrist and all the fellows turned up, even though it was 11 o'clock at night, to watch. We all just rang each other up and that was the spirit that the consultant body engendered in its fellows. We were very much a team. I've never really worked anywhere before or since that had that sort of atmosphere. It was very unique and quite superb. The other benefit of going away on fellowship was that I was able to work incredibly hard during the week often until later in the night and travel home to Plymouth at the weekend to be with my family. This allowed me to really concentrate and do a huge amount of work in what felt like a short period of time.

What motivated you to specialise in hand surgery, and how has your training shaped your approach to patient care?

I trained in the peninsula training rotation in Devon and Cornwall and I had a fantastic experience there. It was a very busy rotation with heavy emphasis on trauma and I rotated between Derriford in Plymouth, Treliske in Cornwall and the Royal Devon and Exeter Hospital in Exeter. All in all I just was inspired more by the hand surgeons that I worked with than the other surgeons. You get to sit down to operate! Your operations don't really last more than two hours and although as a consultant, I did major trauma at Southampton, hand and wrist was always my first love. I love the fiddliness of the myriad of anatomy in such a small space and also how hand surgery plays second fiddle to a lot of other areas in the body. I quite like that because it means we can go under the radar with the amazing things that we do and then suddenly people go "Wow, you're doing what? That's amazing". like the new tiny miniaturised hip replacements we’re putting in in the base of the thumb that Alistair Jepson talked about in a previous OrthoSpaceX edition, ultrasound guided surgery through an ultra minimally invasive incision for things like carpal tunnel and Trigger finger and using anaesthetics which is obviously my passion.

You won the British Society for Surgery of the Hand (BSSH) prize for your instructional video on Wide Awake surgery. Can you tell us more about the video and its impact?

This video was the result of a collaboration with myself and Nik Jagozinski, who now works in Barnstable. We went over to see Don Lalonde in New Brunswick, who is a sort of godfather of Wide awake local anaesthesia no tourniquet (Walant) surgery. When we saw him he was talking about writing a book but was loath to because of the amount of work involved because it is enormously heavy going coordinating a lot of other people to write the chapters with you but we finally persuaded him to. While we were there we recorded a lot of video footage of how he did things and what operations can be done under Walant and edited those into the video that we submitted to the BSSH. Nik and I were delighted to win the prize and having had it up on Vumedi and my Walant channel, it has been viewed nearly 10,000 times! I didn't realise it would take off quite in the way it has done but it has also taken a lot of work!

What inspired you to contribute to the book "Wide Awake Hand Surgery" by Don Lalonde, and what was your experience like working on this project?

As I mentioned above, we saw Don at home in New Brunswick, Canada and persuaded him that everybody needed to hear what he had to say. The book reads like watching him in one of his clinics! It is a complete regurgitation of his thoughts and it is wonderful. It's now on its second edition and all proceeds go to charity and in particular the Lean and Green sponsored by the American Society for Surgery of the Hand to promote more environmentally friendly practices in hand surgery.

Can you walk us through a typical patient journey when undergoing hand surgery with the "Wide Awake" technique?

One of the beauties of wide-awake surgery using local anaesthetic and adrenaline is that it is incredibly patient centred. Lots of people or institutions say they are patient centred but in reality they still have bills to pay and/or shareholders! Walant is simply a local anaesthetic technique and all the benefits of using local anaesthetic apply to it. Things such as you do not need a pre assessment, you do not need to stop taking any medications including anticoagulants before surgery. Because we're not using a tourniquet which is the big difference between Walant and simple local anaesthetic we do not need anaesthetist to take away the pain of the tourniquet and we are not restricted with time. A person can really only hold on to a tourniquet for 15 to 20 minutes whereas the one percent Lignocaine with 1:100 000 adrenaline will last for 4 to 5 hours. Because there are less people in the system it's much more efficient for patients so they can arrive later and leave earlier. The other big issue with a lot of operations in orthopaedics is that patients are not informed and educated well enough in my opinion. During a wide-awake operation we have the opportunity to not just vindicate their pain by telling them/showing them the pathology and how bad it was but also educate them about what I'm going to do to fix it and that I have fixed it more importantly. We can then check our reconstructions/repairs so that we and the patient have confidence to mobilise early after the operation with impunity. That is amazingly important for patients and I should know...I've had my own hand operated on under Walant. I was able to see that it was now fixed and I could carry on with my career. It was a moment I shall never forget!

You contributed to the BSSH Walant Handbook as a free resource for hand surgeons worldwide. Can you share some insights into the development of this handbook and its intended impact?

This was an extremely important project to me because it was a collaboration. Covid was a very difficult time as we are all aware for surgeons and patients and having the evidence to allow hand surgery to continue and to extol the virtues of Wide awake surgery globally was a marketing dream for Walant! The handbook was taken up by many societies abroad as well which was very pleasing to see. It was downloaded many thousands of times. It involved some of the foremost authorities in the UK on Wide awake surgery and it was an honour to be part of that.

With more than 15 peer-reviewed articles and ongoing research projects, can you highlight some of the key findings or areas of interest in your research?

What's interesting about when you're a trainee is that you really generate research articles that you're told to write! All of these projects were collaborations of course but I'm not a huge fan of research if the truth be told! There are some good papers out there but I could probably count them on one hand, or at least the ones that have changed my practice. I fundamentally believe that no matter how much research goes on, actually doing the operations we have currently, but better and looking after our patients in a more patient-centred manner will benefit those patients far more than finding out new evidence for whatever we have chosen to look at with our registrar! If we can genuinely build systems and processes and the patient journey around an amazing patient experience I believe the patient will be happier, get better service and also more importantly get better more quickly. I have the privilege to be able to do that for my patients now and it is my all consuming passion at the moment. I feel very strongly that doctors and more importantly surgeons, should be given much more time and resources to spend communicating with patients and that would benefit patients far more than any more research! I appreciate why people want to do research because it's interesting and pushes the boundaries but I think there is far too much of it and it should be more collaborative with large institutions or societies coordinating exactly what research questions need answering rather than churning out the results of my last 50 this or that operations! Call me controversial but the balance is wrong in my opinion.

What aspects of hand surgery do you feel are most important for future generations of surgeons to understand?

There is increasing evidence to support minimally invasive surgery with scars and skin adhesions causing pain post-operatively that is just not necessarily needed. I use ultrasound to guide my carpal tunnels and trigger fingers and the results are spectacular! It utilises a 3 mm incision instead of a 2-3 cm one and my patients have told me that they are back to "normal" after 7 to 8 days instead of 2 to 3 weeks. It has opened my eyes to the potential of ultrasound and I now use it for as many things as I can! I've also started to use it to define pathology in clinics and it is very good for educating patients because they can see the pathology and again, feel vindicated that they are not making it up! Equally I think the pressure on future generations will be to do more for less with less resources, less support and with less incentive. I think we are at a very critical juncture in medicine and particularly the NHS. It is a huge concern of mine that the doctors of tomorrow are inheriting a broken system which is going to break them. It's not all doom and gloom. I'm sure that the Phoenix will rise from the ashes but it is also interesting to see what techniques and personalities will flourish and maybe this is just evolution happening at a much faster pace! The NHS is unlike almost every other system in the world and I love it for what it stands for but not for what it gives patients. Most patients have an excellent experience despite not because of the service itself. That is what I think the future generations of surgeons will have to grapple with and the pace of change is going to be huge with things like artificial intelligence and robotics. It's a very exciting time!

What advice would you give to aspiring hand surgeons or medical professionals interested in pursuing a career in orthopaedics?

Orthopaedics is the absolute best career within medicine! I would definitely not have done anything else and any potential orthopods out there thinking of doing hand surgery can come and join me and I will enthuse them to the end of the world. Hand surgeons tend to be extremely nice people. There are always exceptions but when you look at hand surgeons in a room there is a lot less ego and a lot more emotional intelligence on the whole. If that sounds like you then give me a call and come and join me!

Looking ahead, what are your aspirations for the future of hand surgery, both personally and professionally?

I am generating multimodal education for patients and my aspirations are to be able to offer patients reliable and trusted information that is relatable so that they can reduce their anxiety and feel more secure about their choices.

What's incredible, as a patient recently having broken my own shoulder and had to have it fixed (three-part proximal humeral fracture - skiing!), is that I had zero anxiety even from the moment I remember breaking it onwards. I knew when I needed to have it fixed, who was going to fix it, who was going to put my regional anaesthetic in, what my rehabilitation was going to be like because I have fixed many shoulders in my life. I suddenly realised that if you didn't know any of that, the anxiety for your future function, work, hobbies, and home life could be paralysing.

We, as doctors, need to understand that patients are deeply anxious about their problems and we can either alleviate that or not. That is my aspiration for the future of hand surgery personally and professionally. I am currently creating videos, slide decks, blog posts, FAQs, a chatbot and a new website as well as starting generating TikTok, Instagram, Twitter and Facebook accounts and content. Digital marketing for not just our own brand but for hand surgery in general is a huge opportunity. We need to grasp it or fall behind!

Mr. Alistair Phillips

Mr. Alistair Phillips exclusively specialises in treatment of hand, wrist and elbow conditions, and has a special interest in the use of local anaesthetics. Mr Phillips performs many surgeries under local anaesthetics that would traditionally have been undertaken using a tourniquet and/or a general anaesthetic, and is now concentrating on this technique as he has seen first-hand the various benefits to patients.

His empathy for patients is obvious from the first meeting, and he has specifically designed his pathways to place the patient at the centre of his care - reducing inconvenience and needless appointments, performing the injections of local anaesthetics almost painlessly, only operating when absolutely necessary and providing as much information as possible before, during (as patients are awake, and alert) and after surgery to keep patients as educated and involved in their own care as possible.

He is the co-founder and chairman of a charitable website which seeks to educate surgeons from all over the world about this technique - Wide Awake Local Anaesthesia No Tourniquet (WALANT). He has lectured internationally on the subject, and was invited to speak at the combined Belgian and Dutch Hand Societies meeting in March 2019, and also to be faculty at the inaugural WALANT course in the UK, in Wrightington, in May 2021.

Read more about Mr. Phillips’ practice here

We would like to thank Mr. Alistair Phillips for his time and insight into orthopaedic excellence.

Thank you to our sponsor:

JRI Orthopaedics

To download this issue of On The Podium , click below.

Putting Your Best Foot Forward: Insights from Foot & Ankle Specialist - Mr. Nikhil Nanavati -

Mon, 08 Apr 2024 08:58:51 GMT

Putting Your Best Foot Forward

Insights from Foot & Ankle specialist

— Mr. Nikhil Nanavati —

Issue 08, March 2024

Can you talk us through your training pathway and your decision to specialise in Foot and Ankle Surgery?

I completed my medical school training at Brighton/Sussex Medical School and subsequent specialist orthopaedic training in Sheffield. I went on to complete a specialist fellowship in foot and ankle surgery in Leicester with the immensely talented Miss Patricia Allen.

I have been extremely fortunate to have worked alongside some very influential and talented figures in the world of foot and ankle surgery including Mr Chris Blundell (Sheffield), Mr Mark Davies (Sheffield), Miss Patricia Allen (Leicester), Mr Jitendra Mangwani (Leicester) and Mr Maneesh Bhatia (Leicester). Three of these people have been Presidents of the British Foot and Ankle Society and I expect the other two to become Presidents in the future.

These are not ordinary people that I have trained with - their everyday levels, performance and unwavering enthusiasm for the speciality of foot and ankle surgery means that they are at the very top of their game. It has been a privilege to undertake learning opportunities from these mentors as I feel the same sense of commitment to the speciality that they have been devoted throughout their careers.

I would like to think that I've taken some of the best bits from each of their own methods but the overall aim is to strive for perfection in every surgical procedure performed.

I really enjoy the planning required for each procedure and variability within the subspecialty - every operation I perform is different but very patient-specific.

Are the any pivotal moments during your training that influenced you?

Surgical technology within the field of foot and ankle surgery has advanced so much in recent years that we're now at a stage of performing 3D-printed implants to replace bones within feet and ankles for problems that would have previously been treated with amputations.

My exposure to limb-salvage 3D-printing technology in foot and ankle surgery (mainly in Sheffield) inspired me to pursue my ambition of becoming a Consultant Orthopaedic Foot and Ankle Surgeon.

We have recently performed our first 3D-printed hindfoot fusion procedure for a patient in Rotherham who is now more than 1 year post-op. They are doing very well and back to heavy work with a condition that would have potentially required an amputation a few years ago.

Overall the aims for my patients are the same; to be pain-free, wear shoes and walk again which is such a fundamental part of human existence.

How did working alongside three BOFAS presidents prepare you for being a consultant?

My transition to becoming a consultant was made a lot easier by working for my previous mentors. They supported me throughout my training, taught me multiple skills and were influential figures in my career. Their technical abilities, planning of procedures and patient-care was constantly first-rate so I don't think I felt the pressures of clinical practice as much as some when I first started as a consultant.

From working with these people, I also had a flavour of the political situation within the field of foot and ankle surgery across the country. It is my ambition that patients are afforded the best possible, patient-specific care for their conditions from people who are appropriately trained and qualified to treat them. Patients should be aware of the qualifications and limitations of any practitioners treating them for their foot and ankle problems.

You were awarded the BOFAS Fellowship in Malawi, can you talk about this experience and what you learned both professionally and personally?

One case that stood out for me was a crocodile bite causing traumatic above knee amputation which is something I am unlikely to see again but provided me with exposure to surgical anatomy and fundamental principles which I carry-over into my everyday practice.

Another case was a young child who had stolen some fruit from a farm as they couldn't afford food. The farmer had caught the child and tied his hands behind a tree for more than 12 hours as a punishment. This led to a compartment syndrome of the child's forearms and ultimately permanent loss of use and function of his arms/hands.

I also went on to see crocodile bites, snake bites and delayed/neglected presentation of traumatic injuries. My exposure to surgical anatomy was unparalleled given the conditions that patients presented with. There were also very limited resources to perform operations which definitely developed my ability to think and adapt under pressure as well as developing multiple strategies for tacking various problems so I always have options available when surgically treating my patients.

During my downtime, I was also lucky enough to visit many nature reserves including safaris around Malawi with a local tour-guide.

From a personal perspective, the people of Malawi were always friendly, happy and respectful despite the daily struggles they faced. They were always appreciative of the care we provided during my time there and it made me feel extremely lucky to live in a country with a high-class medical infrastructure such as the NHS.

Congratulations on being an ATLS Instructor, what's involved in this process?

I've been an advanced trauma life support instructor (ATLS) instructor since 2013 and was lucky enough to have been selected for this teaching post. In order to be selected, you must perform and score at a high standard during an ATLS exam, following which you will be invited to train as an instructor.

I have now taught on multiple ATLS courses which always prove to be very rewarding experiences. The aim is to teach doctors about life-saving skills which they take forward into their everyday practice in the future.

I am also delighted to announce the I have recently become the course director for our first local ATLS course taking place in Rotherham NHS Foundation Trust later this year and I am looking forward to this new challenge.

Do you see any further opportunities to develop the training options for junior doctors?

Training opportunities have become more limited for doctors since the introduction of the working time legislations along with the provision of allied health professionals undertaking further sub-specialist training.

When trainees are working with me in foot and ankle surgery, I think it's extremely important for them to learn and train in a peaceful, calm and non-judgemental environment - these are the best conditions for achieving excellent surgical outcomes in my eyes. Those who know me know that I have high expectations but if the ground-work has been done, these expectations are usually matched in the theatre-setting. I like to ensure that my trainees have read up on cases before the day of surgery as well as reviewing patients post-operatively on the ward and in clinics.

I have personally found it is just as important to develop interpersonal skills required in the clinic setting as well as surgical skills in theatre. Developing a rapport with patients and ensuring they feel their problems have been heard is a challenge in a busy clinic but I strive to give all my patients a good experience and I try to instill this attitude into my trainees.

We noticed you're also working in a management role at Rotherham can you tell us more about that?

I have been deputy divisional director of surgery at Rotherham NHS Foundation Trust for the past 18 months and have found this job role to be extremely challenging and rewarding at the same time. I came into this job following the COVID-19 outbreak at a time where significant challenges were faced with the recovery of elective surgery within the NHS.

The reason I took on this role is because I want to help our surgical division reach its full potential. We need to ensure that patients experience high-quality care, staff feel valued and we have a strong sense of camaraderie amongst the surgical teams.

We have an extremely strong and clinically-led team within our surgical leadership team (SLT) who have to make difficult decisions under challenging circumstances and as part of this role, I sit on multiple meetings working with my multidisciplinary colleagues to develop robust strategies to support the safe provision of surgical care in our trust. Recent emphasis has been on theatre efficiencies, staffing models and improving patient/staff experiences within our unit.

The role can be challenging as management and clinical opinions can be varied but it is very important to see both sides of view, rationalise opinions and come to a balanced consensus that is agreeable where appropriate.

Do you have any advice for consultants looking to combine clinical roles with management?

These job roles aren't easy because decision-making isn't easy - every decision won't be popular with every respective individual so as a result, some people are always disappointed. However, if your overall aim is to improve and progress a department with a team-based vision and approach, it can be a really rewarding and valuable experience. Moreover for me, it has quickly taught me about the inner-workings of NHS infrastructure, local challenges and hospital systems which I hope to be able to utilise in my future clinical and management practice.

Mr. Nikhil Nanavati

Mr Nanavati is a consultant Orthopaedic Surgeon specialising in foot and ankle surgery. He is an expert in the generality of foot and ankle surgery with specialist skills in sporting injuries, key hole surgery and complex deformity correction. He was a student at The Manchester Grammar School, studied medicine at Brighton/Sussex Medical School and completed his orthopaedic training on the Sheffield, South Yorkshire rotation.

Mr Nanavati has worked alongside 2 past presidents of the British Foot and Ankle Society which included a 16 month fellowship with Miss Patricia Allen in Leicester. He has undertaken a trauma fellowship in Malawi, Africa and completed a post graduate masters in orthopaedic Engineering (Cardiff) which he passed with Merit. He ranked 11th in the country in his orthopaedic training entry exam and 4th in Yorkshire in his basic surgical training entry exam. He is the Deputy Divisional Director for Surgery in Rotherham, and he has won awards for innovation in orthopaedic surgery, as well as an NHS Clinical Excellence Award for Services to Foot and Ankle Surgery, published in multiple journals including the British Medical Journal and is an Advanced Trauma Life Support instructor.

Mr Nanavati was selected as part of a team of highly prolific names in foot and ankle surgery from around the world to write a chapter in ‘Essentials of Foot and Ankle Surgery’ which is an internationally recognised gold standard book. He is vastly experienced in writing medicolegal reports and has developed a reputation based on the quality of his reports, efficiency of his work and responsiveness to any questions posed. He is a member of the British Foot and Ankle Society (BOFAS).

In his spare time he enjoys running, walking his dog and spending time with his young family.

Mr Nanavati is known as the Yorkshire Foot Surgeon and has his own website detailing a range of additional information. This ranges from the treatments and aftercare he offers to patients, to useful patient information files on a range of his treatments.

We would like to thank Mr. Nikhil Nanavati for his time and insight into orthopaedic excellence.

Thank you to our sponsor:

JRI Orthopaedics

To download this issue of On The Podium , click below.

The CTC (“Closing the Circle”) Technique An Innovative approach to treating AC Joint Stabilization. An Interview with Ana Catarina Ângelo, M.D.

Mon, 26 Feb 2024 08:28:35 GMT

The CTC (“Closing the Circle”) Technique

An Innovative approach to treating AC Joint Stabilization

An Interview with:

— Ana Catarina Ângelo —

Issue 07, February 2024

What initially drew you to pursue a career in orthopaedic surgery, and what motivated your decision to specialise in shoulder and elbow surgery?

Well, since the beginning of medical school I always wanted to pursue a surgical career. I like intervention, and the act of physically correcting something that is wrong fascinates me. When I was in the last year of medical school I fractured my tibial plateau and that unexpected contact with the orthopedic reality made me realize that O&T was the right choice for me. Also, I quickly realized that this specific surgical field was evolving a lot, with new understandings and new techniques, and I personally like the idea of being part of the evolution of my field. Shoulder and elbow was love at first sight. The biomechanics of the shoulder girdle fascinated me and the “unknown” elbow world was a super appealing challenge. I decided to become a shoulder and elbow surgeon in the second year of my residency. This made me super focused on this specific subject since the beginning. I started attending a lot of advanced courses very yearly to develop my technical and theoretical skills. When I finished my residency, I already felt very comfortable in the majority of the surgical procedures and with the theory behind them. A super important point is that I’m lucky enough to work alongside my partner Prof. Clara Azevedo, who highly contributed to my steep evolution in this field.

Could you share some of the most rewarding moments and challenges you've encountered in your journey as a shoulder surgeon?

For sure. My journey has been marked by some challenges but, luckily, the balance is highly pending to the rewards side. Obviously, the fact that I am a woman brought me some challenging moments when I started my career in a still very masculine field like O&T. But I had a lot of support from senior female surgeons in my department and this aspect quickly became a non-issue.

When I chose to focus on shoulder and elbow in a very early phase of my residency I was criticized, and for a few years I struggled with keeping up with my goals. But honestly I would do it all again, exactly the same way. Resilience is important in our field, and learning how to deal with criticism and failure is a must if you want to be a successful surgeon and scientist. This takes me to my first publication in a Q1 peer-reviewed international journal, which is definitely one of the most rewarding moments of my career. When Clara and I published our first results regarding SCR (superior capsule reconstruction) and donor site morbidity associated with our harvesting technique I felt like I was finally leaving my footprint in the amazing field of shoulder surgery. What a feeling. Our careers have sky-rocketed since then and it has been an extremely rewarding journey. Getting to know, befriend and exchange ideas with the best "shoulder and elbow minds” from all around the world is priceless. This is my biggest reward and I wouldn’t trade it for a calmer and less stressful life.

Looking ahead, what are your aspirations and goals within the field of shoulder surgery, both in terms of advancing clinical practice and contributing to research and education in the field?

Well, I feel very excited with what I see coming ahead. Generally, my goals focus on continuing research regarding the treatment of irreparable rotator cuff tears and the role of superior capsule reconstruction using a fascia lata autograft. This technique has been highly misinterpreted in the literature, mostly due to the introduction of several allografts that are not ideal and produce inferior results. We have a good pool of patients and we’re beginning to have a long follow-up that will allow us to better understand how this technique can influence the natural history of irreparable rotator cuff tears. Another field that we aspire to somehow improve is the treatment of anterior glenohumeral instability using a new and interesting soft tissue technique called DAS (dynamic anterior stabilization). This reproducible technique theoretically allow us to treat patients with limited to subcritical glenoid bone loss using only soft tissue, while adding stabilization effects that were previously only obtained with bony procedures. The preliminary results are very good, but, like with any technique, it still needs to pass the test of time. So, we’ll keep following our patients to find out if this technique works in the long run. Finally, the CTC technique is also one of our main present and future study subjects. We developed the CTC do address some problems and probable causes of failure that we encountered in our practice and in the literature regarding the surgical stabilization of the coraco-acromio-clavicular complex. We started doing it in 2018 and we plan to review our pool of patients and statistically and clinically assess the mid-term results.

Can you elaborate on your "Closing the Circle" technique for acromioclavicular joint stabilization and how it addresses the tridimensional stability of the joint?

As I said before, we felt the need to design this technique to address some insufficiencies of the techniques that we previously used. AC joint stabilization techniques have a high failure rate mostly due to the fact that for many years there was an insufficient knowledge about the biomechanics of the AC joint complex. Treatment modalities were very focused on reestablishing vertical stability in one plane, and this would only make sense in low grade lesions (Rockwood I, II and IIIA) in which conservative treatment is highly successful. In high grade lesions there is usually a compromise of both CC and AC structures as well as a tear in the deltotrapezial fascia. This usually results in a tridimensional instability - vertical, horizontal and rotational. To correct this complex instability we should address the 3 planes of motion, which is impossible to achieve with a single implant that reconnects the clavicle to the coracoid in one plane. Our goal was to design a technique that allowed us to recreate the biplane vertical stabilization of the conoid and trapezoid CC ligaments, while also addressing the AC joint ligaments and capsule and the deltotrapezial fascia. To minimize complications related to metallic implants and wide bone tunnels we replaced the subcoracoid buttons by 2.8mm all-suture anchors that actually work like “soft tissue buttons”, and we use the 2.9 drill to pass the anchors and the sutures through the coracoid, the clavicle and the acromion. By placing 2 anchors in the coracoid, one double-loaded and one triple-loaded, we are able to reconnect the coracoid to the clavicle in 2 vertical planes, mimicking the trajectory of both CC ligaments, and also to cerclage around the ACjoint using sutures coming from these same anchors. The AC joint is stabilized in an "open figure of 8” fashion, theoretically allowing clavicular and acromial rotation without compromising horizontal stability. We perform this technique through an open approach which allows us to properly repair the AC capsule and the overlying deltotrapezial fascia. It is very important to mention that this technique has been designed for acute high grade AC joint injuries (up to 3 weeks after trauma).

What biomechanical principles underlie your approach to addressing both vertical and horizontal instability in AC joint dislocations?

The role of horizontal stabilization in the treatment of high grade AC joint injuries has been extensively studied in the last 20 years. But actually, in 1986, Fukuda and colleagues (Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986 Mar;68(3):434-40. PMID: 3949839.) had already established that the acromioclavicular ligaments and capsule played a crucial role in the posterior displacement and posterior axial rotation of the clavicle. In the early 2000 the group of Richard E. Debski from the university of Pittsburgh published a biomechanics cadaveric study in which it the authors concluded that both the AC capsule and the 2 coracoclavicular ligaments help to resist translation during application of external loading conditions in the posterior, anterior and superior directions, but in different proportions. This means that during range-of-motion there’s a complexity of restraining forces that work together and in varying proportions to maintain tridimensional stability of the coracoacromioclavicular (CAC) complex. The CTC technique was designed to recreate the spheric structure of this anatomical complex to be able to accommodate all translational forces involved during full ROM.

How does your technique consider the complex anatomy of the AC joint and its relationship with the coracoid process in achieving stability?

The CAC complex connects the clavicle to the scapula in 3 distinct points: 1) the AC capsule and ligaments; 2) the trapezoid ligament; and 3) the conoid ligament. These 3 connection points have different shapes and vectors that correlate with their specific biomechanical role as AC joint stabilizers. The CTC technique also involves 3 connection points – 2 vertical coracoclavicular connections with different vectors to recreate the conoid and trapezoid roles, and a figure of 8 around the AC joint to simulate AC capsule and ligaments.

Could you share a case study or example where you successfully applied your technique, and what were the outcomes observed in terms of joint stability and patient recovery?

Of course. So, this is a case of a 28yo female patient, plays soccer not professionally, fell and sustained a grade IIIB AC joint dislocation with a severe horizontal instability component. In all my AC joint patients I explain the natural history of the lesion and the good functional results obtained in many cases with a conservative approach. The only patients that undergo surgery are the ones who actually choose this treatment. She was in a lot of pain and didn’t want to risk the need to undergo a more invasive surgery in a later stage if pain and dysfunction remained after 6 weeks. Her CC distance was approximately 2 times the healthy side in a zanca view and the axillary velpeau showed a completely posteriorly displaced clavicle.

Figure 1

Figure 2

Figure 3

What specific patient positioning and surgical setup do you find most conducive to performing the "Closing the Circle" technique effectively?

This is a technique performed completely open, we stopped doing the “arthroscopic-assisted” part of the surgery to control coracoid drilling and implant positioning. This means that in this technique the coracoid drilling and anchor placement are performed under fluoroscopic visualization. To optimize this step we should be able to obtain a “zanca view” in the OR. The patient should be positioned in a lazy beach chair and the scapula should be completely free. Scapula mobilization can also aid in a correct reduction intraoperatively. We find that using a mechanical arm-holder makes the reduction easier.

What are some common challenges or pitfalls encountered during the procedure, and how do you navigate them to ensure optimal outcomes?

In my opinion the most challenging but also key points are the following:

1 Make sure to properly deliver the all-suture anchors well underneath the inferior cortex of the coracoid. The anchor has to go all the way through the inferior cortex so it can properly deploy as a button;

2 Reference your sutures so that you can do a proper suture management and know which sutures come from which anchor;

3 Use a nitinol wire to shuttle the sutures through the drill holes. Sometimes you have to be patient and persistent to find the nitinol underneath the clavicle or in the posterior hole of the acromion. Using a small hemostat clamp to gently dissect the soft tissues and your tridimensional spatial orientation can be helpful.

4 Avoid extensive effort to hold the reduction. Just use an arm holder to shrug the shoulder while you’re tying the knots of the construct.

Your postoperative rehabilitation protocol emphasises early mobilisation. Could you explain the rationale behind this approach and its impact on patient recovery?

We are big fans of early mobilization. Generally, all our patients start moving early but in a controlled manner. This technique is used to treat acute dislocations, so conceptually this is just a temporary construct to allow proper function while the anatomic structures heal. In the first weeks we allow mobilization in a ROM that doesn’t particularly stress the AC joint. We focus on mobilization below the shoulder level and avoid adduction, specially against any resistance. We believe that it minimizes the chance of rotation deficits after surgery. Also, from a psychological point of view, this actively includes the patient in the rehabilitation process since day 1.

How does your technique compare to other existing methods for AC joint stabilization in terms of efficacy, complication rates, and long-term outcomes?

In order to answer this I would have to have done a comparative clinical study or at least a systematic review comparing the different techniques. Unfortunately I do not have that specific data yet. But let’s talk again in a couple of years!

Considering the complexity of AC joint injuries, how feasible do you think your technique is for adoption in various healthcare settings, including those with limited resources?

Well, the fact that all the arthroscopic setting gear is out of the way makes this technique more feasible to the non-arthroscopic surgeon and considerably cheaper. The all-suture anchors are available in almost every country, and the buttons on top of the clavicle can be easily replaced by a small low profile 1/3 tubular plate if needed. No need for specific drills, drill-guides or special instrumentation.

Have you collaborated with other institutions or researchers to further study the effectiveness and refinement of your surgical technique?

We’re currently starting a collaboration with Instituto Superior Técnico (IST) in Lisbon and Universidade do Minho in Braga to further study the biomechanics and mid-term clinical results of this technique. These studies are part of my PhD project.

What are your aspirations for the future development and refinement of the "Closing the Circle" technique, and do you envision any adaptations or modifications based on ongoing research or clinical feedback?

We’ve been adapting the technique to a point in which I honestly think that there is not much more to improve. I’m a huge fan of small incisions/minimally invasive surgery, so in each patient I keep pushing for a smaller incision, just to keep it aesthetically more pleasant. The one thing that would make the technique more easy is the shuttle system.The nitinol wire is fragile and sometimes not easy to find in the soft tissues surrounding the joint. So if we find a way to improve this it will definitively positively impact the surgical moment.

We would like to thank Ana Catarina Ângelo for their time and insight into orthopaedic excellence.

Ana Catarina Ângelo, MD.

Ana Catarina Ângelo is a Shoulder and Elbow Orthopedic surgeon based in Lisbon, Portugal, she is co-founder of SHOULDER.PT and member of the shoulder and elbow units of Hospital dos SAMS de Lisboa and Hospital CUF Tejo in Lisbon, Portugal. She completed her master's degree in Medicine in 2011 at Faculdade de Medicina de Lisboa, Universidade de Lisboa, and her orthopedics and traumatology residency in Centro Hospitalar de Lisboa Ocidental. During residency she completed international fellowships in shoulder and in elbow surgery centers in France and Belgium. Between 2014 and 2019 she was actively involved in the academic training of medical students from NOVA medical school, in Lisbon.

National and international lecturer, with several communications as invited faculty in national and international events. In the last 5 years has been devoted to clinical and biomechanical investigation in shoulder surgery, with several papers published in scientific peer-reviewed national and international journals.

Scientific reviewer for several international peer-reviewed Q1 papers including AJSM, OJSM, JSES, KSSTA, JEO and Clinical Biomechanics since 2017.

She is an active member of the Portuguese Society of Shoulder an Elbow surgery, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) since 2017, invited member of the communication committee of the European Shoulder Associates (ESA) between 2020-2022 and current member of the ESSKA-ESA scientific committee. Since 2021 Ana Catarina Ângelo has become an active member of the International Society of Arthroscopy Knee Surgery and Orthopedic Sports Medicine (ISAKOS) and a current member of the ISAKOS Communication committee. Since 2022 she has also become an ordinary member of SECEC and was elected member of the SECEC membership committee in 2023.

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Innovating Hip Replacement Surgery: With Professor Paul Lee December 2023 — The SPAIRE Technique —

Wed, 20 Dec 2023 12:36:21 GMT

Innovating Hip Replacement Surgery:

With Professor Paul Lee

— The SPAIRE Technique —

Issue 06, December 2023

Could you share with us your journey into orthopaedic surgery and what led you to specialise in the SPAIRE

technique for hip replacement?

My journey into orthopaedic surgery was driven by a passion for advancing patient care through innovative techniques. The SPAIRE technique caught my attention due to its focus on muscle preservation and minimally invasive approach. It aligns with my dedication to regenerative medicine, offering patients a more natural and less disruptive option for hip replacement. The technique’s potential to reduce recovery times and enhance overall patient outcomes was a key factor in my decision to specialised in it.

Can you elaborate on the key elements of the SPAIRE technique and how it differs from traditional hip replacement approaches

The SPAIRE technique is innovative in its approach to hip replacement. It involves a modified posterior approach, carefully preserving muscles like the piriformis and obturator internus. This differs from traditional methods by reducing the need for muscle reattachment and decreasing the risk of dislocation, leading to a more natural hip function post-surgery.

In your experience, what are the primary benefits of the SPAIRE technique for patients undergoing hip replacement surgery

The primary benefits include reduced postoperative pain, quicker recovery, and improved stability. Patients often experience better mobility and a faster return to their normal activities.

How has the SPAIRE technique impacted patient recovery times and long-term outcomes compared to conventional methods?

The SPAIRE technique has significantly enhanced patient recovery times. Most of my patients have reported less discomfort and quicker rehabilitation, leading to a more satisfying postoperative experience.

What challenges have you encountered while implementing the SPAIRE technique, and how have you addressed them?

One challenge has been adapting the surgical technique to different patient anatomies. I've addressed this by customising the approach for each patient, ensuring the best possible outcome.

Could you discuss any ongoing research or future developments in the SPAIRE technique that you are currently involved in?

My team and I are constantly exploring ways to refine the SPAIRE technique. We're involved in ongoing research to further understand its long-term benefits and potential enhancements.

What has been the most rewarding aspect of utilizing the SPAIRE technique in your surgical practice?

The most rewarding aspect has been witnessing the positive impact on my patients' lives – seeing them regain mobility and return to their daily activities with ease.

As an educator, how do you incorporate the SPAIRE technique into training and education for upcoming orthopaedic surgeons?

I incorporate the SPAIRE technique into surgical training programs. It's crucial for upcoming surgeons to be adept in modern, minimally invasive techniques.

How do you determine if a patient is a suitable candidate for the SPAIRE technique?

Patient selection is based on a thorough evaluation of their condition. Factors like the severity of hip degeneration, overall health, and lifestyle play a crucial role in determining suitability.

What future advancements in hip replacement surgery do you anticipate, and how do you see the SPAIRE technique evolving in this context?

I anticipate further advancements in minimally invasive techniques and biocompatible materials. The SPAIRE technique will continue to evolve, incorporating these advancements to provide even better outcomes for patients.

Professor Paul Lee

Professor Paul Lee is a consultant orthopaedic surgeon based in London and Grantham, Lincolnshire, specialising in hip replacement, knee surgery and knee cartilage replacement alongside revision hip replacement, meniscus surgery and anterior cruciate ligament (ACL) surgery. He privately practises at 108 Harley Street medical centre and as the director at MSK Doctors in Ancaster, Lincolnshire. His NHS base is United Lincolnshire Hospitals NHS Trust where he is a consultant sports and arthroplasty surgeon and the Director of Research.

Professor Lee is highly qualified, and received his MBBCh in Medicine from Cardiff University in 2005 and went on to receive an MSc in Sports Medicine - Muscle Performance and Recovery, from Cardiff Metropolitan University three years later. He then returned to Cardiff University to complete a PhD entitled 'Treatment of Muscle Injuries' in 2013.

He regularly treats elite sports people, including treatment of muscle injuries in UK Premier League footballers, significantly reducing their recovery time, allowing them to return to playing sooner.

Further to his qualifications, Professor Lee also has various fellowships from respected institutions including the Royal College of Surgeons of Edinburgh (Tr & Orth), the European Board of Orthopaedics and Traumatology (FEBOT) and Orthopaedics Hospital in Oswestry.

He is also a certified expert in the use of the Exeter hip system, which was developed after training on the Robin Ling Exeter Hip Replacement Fellowship in the Princess Elizabeth Orthopaedic Hospital in Exeter. He also did international fellowships in Germany and Australia. Other higher training saw Professor Lee become a certified member of the Faculty of Sports and Exercise Medicine (MFSEM).

Professor Lee is widely published in various peer-reviewed journals and is an active member of the British Hip Society (BHS) , British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA) and the British Orthopaedic Association (BOA) alongside the Biological Knee Society (BKS). He is internationally recognised at the ICRS teaching centre of excellence for his teaching in cartilage and joint preservation surgery.

We would like to thank Professor Lee for his time and insight into orthopaedic excellence.

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Inspiring Orthopaedic Leaders: Educational Excellence in Orthopaedics October 2023 — Mr. Fazal Ali's Story —

Tue, 31 Oct 2023 18:06:53 GMT

Inspiring Orthopaedic Leaders:

Educational Excellence in Orthopaedics

— Mr. Fazal Ali's Story —

Issue 05, October 2023

What has made your career what it is?

There is no one thing that has moulded my career the way it turned out. Hard work has been my main ethos through the years. I am the firm believer that nothing comes without hard work. A bit of luck is always needed. What I mean is that, because of luck, I have chosen some paths and met some people who have positively influenced my career for example Paul Banaszkiewicz, who introduced me to Cambridge University Press and resulted in my manuscript being published as a book.

Failure and learning from failure has had a role to play. I think that the exam or two that I failed along the way has stimulated me to learn my subject to such an extent that it has given me the confidence and skills to teach in a way that makes what I teach easy to understand.

A good network of friends, who themselves are successful in their own careers, is essential to keep the momentum going as we frequently ‘feed off each other’. Working at Chesterfield Royal Hospital has made this possible as all my colleagues and friends there frequently cover me in my absence when I carry out my national duties.

The Kids knee team at Sheffield Children’s Hospital.

Tell me about your clinical practice, in particular the Kids Knee service which seems to be a unique service?

My main practice is at Chesterfield Royal Hospital where I see my adult patients and patients that have transitioned from Sheffield Children’s Hospital. In 2015, together with Nick Nicolaou, we set up a Kids Knee service which involves the management of knee injuries in the child and adolescent and congenital problems related to the knee. This service has grown from strength to strength to the point where we attract referrals from around the country. The service has expanded and there are now two other consultants and a Kids Knee Fellow as part of the service. This Fellow is the first and only Knee Fellowship whereby the trainee can gain experience in knee surgery with an emphasis on children’s knee problems.

Is the International Kids Knee Conference part of this service?

Stemming from our work with the kids our team has established the only International Kids Knee Conference which is biennial and based in Sheffield. It attracts all the top experts in the field from around the world as speakers and also delegates from around the world. The next one will be in June 2024. This has been a major way of sharing information between countries and without doubt has helped to promote the management of kids knee problems amongst surgeons in the UK.

Why do you spend so much time training? And how has this been acknowledged?

Training has always been a big part of my professional life. I guess my style of teaching and training has been influenced by ways I should not train rather than ways I should! By this I mean that much of my own training was from seniors who used intimidation as methods of teaching. I rapidly realised that the best way to encourage the maximum learning was by creating a supportive environment. Simplifying things and teaching in a structured template also seems to work. I also believe that knowledge is wasted if is kept to oneself and sharing it is more fulfilling. These methods have stayed with me through my career and it has been appreciated by all of my trainees. For this I was voted ‘Trainer of the Year’ for my region on 6 occasions until I was awarded the ‘Lifetime trainer of the Year’ in 2015. Subsequent to that it was a great honour for the South Yorkshire training rotation to create an award in my name ‘Fazal Ali Award for Academic Excellence’ to acknowledge the trainee of the year. To date five trainees have been given this award.

Fazal Ali and co-conveners of the International Kids Knee Conference in 2022. Nick Nicolaou and Adil Ajuied.

What about your role as an examiner?

My journey as an examiner for the FRCS Tr&Orth started in 1989 September when I arrived in the UK to write the old style part 1 - Primary FRCS. I remember arriving with a suitcase and a pile of books and staying at No 10 Hill Place in Hill Square, Edinburgh. I remember looking out of the window of my flat, with my wife and looking at the trainees entering the anatomy dissection building and looking in awe at tutors and examiners. 30 years later I recall looking out of exactly the same window, which is now the 10 Hill Place Hotel, and reflecting, again with my wife that ‘who would have imagined’ that I was now Chair of the JCIE Section 1 exam for all 10 surgical specialties! Apart from being on the Board of the JCIE, I was also up till recently on the Board of T&O as their Section 1 Lead. I am also an examiner assessor and a senior member of the JSCFE international FRCS exam. It is because of my belief in the role of an examiner that I have dedicated a large part of my professional career to the exam. And to help maintain standard of orthopaedics in the developing world I have also been integral in the running of exams in countries such as the West Indies and in Guyana.

International FRCS examiners in Dubai 2022.

It seems that you place a lot of importance in orthopaedics in the developing world. Is that true?

I am originally from the West Indies and grew up in Guyana and Jamaica and went to medical school at the University of the West Indies based in Jamaica. I came to the UK soon after graduation with the view that I would do my FRCS exams and return. Unfortunately, I did not pass my Primary FRCS on the first attempt and as a result ran out of money and ended up looking for a job and working. One job led to another and before you knew it I was officially in a training programme.

To some degree my heart is still in my homeland and I therefore dedicate a lot of time and influence in helping to develop orthopaedics in these countries. Some of the things that I have done to help this include:

Including chapters in both of my books: Orthopaedic Examination Techniques and Postgraduate Orthopaedic Clinics on topics related to issues in the developing world.
Lecturing and examining, face to face and virtually, in many countries of the developing world.
Operating with developing world surgeons to teach them techniques
Running, together with my friend James Fernandes, the ISTP (International Surgical Training Programme) rotation in South Yorkshire/Derbyshire, which is an MTI scheme from the Royal College of Surgeons of England, to help train postgraduate orthopaedic surgeons from the developing world for 2 years before they return to their own countries.

Trainees speak highly of your book. Tell me about this.

One of my accomplishments that I am most proud of is the 3rd edition of my book “Orthopaedic Examination Techniques’. This is a labour of love that was written over a period of 2 years. It incorporated my experience of teaching clinical examination for 18 years with my experience of examining postgraduate trainees for over 10 years. This coincided with the covid pandemic where I was self-isolating away from my family who were shielding. This meant that I could dedicate months in isolation rewriting my book to the point where I was very happy with the product! I am particularly proud about the comments related to the new chapters and the comments in relation to the inclusivity and diversity of the book. I will probably be doing one final edition of the book before I retire.

This book is getting great 5-star reviews and is being use around the world as a standard text book. Since its release in 2022, I have been invited on numerous occasions to various parts of the world to give lectures on the content.

Invited to Singapore to publicize my book. Together with other authors of the standard orthopaedic texts: Paul Banaszkiewicz, Stan Jones and Manoj Ramachandran.

Is the Chesterfield Clinical course linked to your book?

Actually, it is the book that followed the course! I started teaching clinical examination as a senior trainee, using techniques I devised and perfected for my own FRCS in 2003. I used my colleagues in the early days to practice with and adjust the techniques suitably. Teaching would take place in my own home in the evenings or in the homes of my colleagues. We would also sometimes use the hospital lecture rooms and even pubs! By that time, I had made my own little teaching manual I used to give as a hand-out. Then my friends encouraged me to formalise this teaching as the demand was coming in from trainees from outside our region to be taught. I therefore teamed up with my colleagues from the Sheffield Children’s Hospital and in 2006 the first Chesterfield-Sheffield Clinical examination course was launched. The ethos of this course has always been to teach the art of clinical examination in orthopaedics. It is not meant as a pre-exam course, although it seems to be used that way! One of the key motives of the course was to allow non-trainees to have a significant proportion of places on this course to give them an opportunity to learn clinical examination as they did not have the benefit of tuition from a training programme. This has always been appreciated by surgeons not in a training programme. This course has become the largest, and most highly recognised clinical examination course worldwide. I gave up the running of it about 7 years ago as I was appointed to the JCIE T&O Board. I still have informal input especially in relation to the teaching styles. It is now expertly run by my younger colleagues from Chesterfield who have taken it into the modern era!

Part of the Chesterfield Course team. Picture taken a few years ago when Jeevan Chandrasenan was in charge.

How does BOSTAA fit in with your professional life?

I joined BOSTAA (British Orthopaedic Sports Trauma and Arthroscopy Association) since the early days of my career. I firmly believe that treating the injured sportsman should not just be isolated to one joint but to the entire patient. This is the philosophy of BOSTAA and I embraced it. Sporting injuries are not restricted to athlete. Everyone, from kids to the elderly, will take part in some form of recreational activity these days. So the work of BOSTAA will help everyone. I am very proud to say that I have risen up the ranks within BOSTAA to Honorary Secretary at present. BOSTAA has an emphasis on promoting educational events including BOSTAA annual conference, BOSTAA at the BOA and Cadaveric courses. We also have an active trainee committee and award annually two of the most prestigious Travelling Fellowships. I am proud to say that since I became Hon Secretary there have been about 150 new members enrolled mainly amongst the senior trainees and young consultant groups.

The BOSTAA Board. I am the Honorary Secretary.

Any final comments?

My career would not have been what it is without the love and support of my wife, my children and my beagle! I have a great network of friends and colleagues who support me. Last but not least, I give credit to my trainees who through the years, by seeing them succeed, have made my hard work worthwhile.

Mr. Fazal Ali

Fazal Ali has a special interest in sports injuries to the knee both in adults and in children. He works at Chesterfield Royal Hospital and the Sheffield Children’s Hospital where he is helping to set up a national referral service for these problems in children. He trained in Sheffield with a Knee Fellowship in Newcastle and a short Trauma Fellowship in New York. He is a former Training Programme Director for South Yorkshire and is presently the Honorary Secretary of BOSTAA ( British Orthopaedic Sports Trauma and Arthroscopy Association) . He is presently Chair of Section 1 of all 10 surgical specialities of the Intercollegiate Board. He has published his work, written chapters and given invited lectures on training issues and knee surgery both nationally and internationally. He has co-edited ‘Examination Techniques in Orthopaedics’ which is a best-selling orthopaedic text and is recently published in Chinese. He is the founder in 2007 of the largest clinical examination course worldwide: The Chesterfield and Sheffield FRCS Clinical course.

Fazal was voted ‘South Yorkshire Orthopaedic Trainer of the Year’ on five occasions. He was given a life-time award for training by the South Yorkshire training scheme in 2015. He was twice shortlisted by BOTA as one of the top trainers in the UK. In 2018 he was again voted Trainer of the Year, this time by East Midlands. In 2017 he was honoured by the South Yorkshire Orthopaedic Training Rotation by the creation of an annual award: The ‘Fazal Ali Award for Academic Excellence’.

He serves as a senior examiner and is a JCIE Board Member for the Intercollegiate Board in the FRCS(Tr&Orth) examinations. In 2017 he was elected to the panel of international examiners. Mr Ali also serves on the board of examiners in other countries with the view that this would help advance the standard of orthopaedic training worldwide.

We would like to thank Mr. Ali for his time and insight into orthopaedic excellence.

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From the NHS to Pakistan: Orthopaedic Excellence Knows No Borders September 2023 — Mr. Mustafa Javed —

Sat, 30 Sep 2023 18:32:06 GMT

From the NHS to Pakistan:

Orthopaedic Excellence Knows No Borders

An Interview with

— Mr. Mustafa Javed —

Issue 04, September 2023

You’ve had an extensive career in orthopaedic surgery with a focus on arthroscopy and keyhole surgery. Could you share some of the most innovative or challenging cases you've encountered in these areas during your experience in Europe and the US?

I have a special interest in management of irreparable rotator cuff tears and joint salvage surgery. My time at the Mayo clinic in Rochester, Minnesota was most memorable. I got to watch and learn tendon transfers, more specifically the arthroscopic assisted lower trapezius transfer which, in my opinion, has been a game changer in shoulder joint salvage surgery and especially in a country like Pakistan, where shoulder replacement surgery can be a costly affair. I’ve been able to offer patients a less invasive and cheaper option for pain relief and restoration of near normal function.

Your educational background includes a wide range of qualifications and training, from MBBS to an MBA in Health Executive. How has this diverse education influenced your approach to orthopaedic surgery and your role as a healthcare professional?

My educational background has certainly helped me to become someone who can think out of the box, can incorporate emotional intelligence into an otherwise labour intense environment, and who can have a practical conversation with hospital management to bring all stakeholders to the table and convince them that all of us are working towards the common goal of improving patient outcomes within the resources available. I used these skills as a consultant in the NHS and now in my hospital in Pakistan.

You've been a member of various orthopedic societies, including the British orthopaedic association and the British Elbow and Shoulder society. Can you discuss the importance of professional networking and collaboration in the field of orthopaedics, and how it has enriched your practice?

You only realise the importance of collaboration with colleagues when you are out in the open and the buck stops with you. I was quick to reach out to colleagues and mentors early in my career and maintained relationships with them not just to discuss difficult cases but also to build bridges between different healthcare systems for mutual learning and growth. I’ve been able to achieve that by organising a yearly meeting and inviting my colleagues from different countries to come to Pakistan and share our experiences with each other. The meeting has now been accredited by the Royal College of Surgeons of Edinburgh and with another coveted British Orthopedic Society.

Given your special interests in trauma and sports injuries, what are some of the emerging trends or advancements in the treatment of these conditions that you find particularly exciting or promising?

One of the most exciting and promising advancements that I’ve seen for sports injuries is the use of tissue regeneration. I often refer to it as a “treatment gap” in patients who did not qualify for surgical intervention and medications and physiotherapy was not enough. We have been stuck in this situation in the past when we used to ask patients to bear with the symptoms and wait for it to get bad enough that we can offer them surgery. Although the jury is out, and we still need concrete evidence to make it standard practice, we are seeing promising results for a selected group of patients with the use of regenerative medicine.

Joint Replacement Surgery is one of your areas of expertise. Could you explain how this type of surgery has evolved over the years and how it significantly impacts the quality of life for patients?

These are very exciting times in the field of joint replacement surgery. In my early years of training we were using standard jigs and “eyeballing” our joint replacement fixations. Don’t get me wrong, the implants were designed in a manner that an average orthopaedic surgeon could do the surgery and offer satisfactory outcomes for patients. The National Joint Registry is a testament to that. But as we have done more and more of these, we have found that precision and accuracy leads to further improvements in outcomes. Patient specific instruments, 3D printing, computer aided navigation and now the use of robots has made all of this possible. These aids have made joint replacement surgery more predictable, reproducible and easier to teach. And most importantly, it has helped in strengthening patient confidence and that directly has a positive impact on recovery and return to some form of normality for them.

What inspired your decision to transition from practicing in the UK to setting up a medical practice in Pakistan?

I think it was never a whole hearted attempt to relocate to my birth country. My wife and I had moved to the UK in 2003 and I’ve gone through the rigorous process of training from a foundation trainee to a core training and then speciality training in the UK, and ending up achieving my CCT in 2016. Following that I did two years of fellowship in Europe and the US in upper limb surgery and sports orthopaedics. I then ended up becoming a full-time consultant in East Yorkshire. Life was good! But I always thought that I needed to give back to the community that I grew up in. As an experiment, I took time off from my regular work to go and help out the community in Pakistan. I was in Pakistan when the pandemic started and that I think was a driver that helped me decide to stay in Pakistan and serve the community here.

Could you walk us through the process of relocating your practice to Pakistan, including the challenges you faced and any legal or regulatory considerations?

I think the process of relocating was exactly similar to when I had moved to the UK. I had to register with the National Health Council of Pakistan and I had to go through a rigorous process of credentialing with my local hospital. My training and UK degrees are accepted in Pakistan which made things a bit easier for a relatively smooth transition. The laws in the country are defined for patient as well as doctor's protection. But these are not easily accessible to the general public, and there is a general lack of legal literacy. Thankfully, my hospital has a legal department which I can speak to for guidance if there is a need.

How did you adapt to the differences in healthcare systems, patient expectations, and medical practices between the UK and Pakistan when you made this move?

It was certainly a culture shock! Having trained my entire life in the NHS, which is a socialist environment, I found it challenging to move to a fairly corporate style of healthcare environment. I work in a fully private set up which has its pros and cons. On one hand, the patient is paying for the entire treatment either through their pocket or through insurance schemes, which means that I have to be mindful and rationalise my plan of action. On the other hand I have some liberty to innovate and I can make the patient experience better through protocols and guidelines that I have learnt during my training in the NHS. Given that I had a template of how orthopaedic practice runs in the NHS, I was able to quickly replicate that in my private practice. I continue to follow the nice guidelines and other guidance from our British societies and organisations related to orthopaedics , and I have not just introduced it into my practice but preaching and propagating to my colleagues here. I have now been able to arrange yearly meetings with like-minded individuals to bring to Pakistan the practices of the west. To keep myself updated, I regularly get appraised and revalidated in accordance with UK guidelines. I’m also lucky to be an examiner for the international exams run by the Royal College Of Surgeons of Edinburgh, this also helps me keep in touch with my colleagues in the UK and to keep updating myself with current practices. I’m also the international surgical advisor for the college in Pakistan and this allows me to help local trainees get guidance on UK training and exams etc.

What strategies did you personally use to successfully build a patient base and establish your professional presence in the medical community in Pakistan?

I’ve been doing exactly how I have been taught and trained to approach a patient or colleagues in the NHS. I was known to be a team player and I carry on wanting to live up to a certain standard set by myself. To develop a practice in Pakistan does mean to start from scratch. Initially it was quite challenging because neither did people know me nor did I know anybody in the community. I registered myself with the National medical council in Pakistan in order to start practicing in the country. I started by attending local and regional meetings. I presented my limited experience within the country. By establishing rapport with colleagues from both Orthopaedic and non-orthopaedic specialities to slowly build up a referral system.

Looking back on your experience, what advice or insights would you share with other healthcare professionals who are contemplating a similar move from the UK to practice abroad?

I would say that anyone who has been through the robust training system in the UK will know how to adapt to any healthcare system in the world. I tell my colleagues who want to move abroad to remember when they moved from one hospital to another during their training. They are trained enough to manage patients to the highest standard. The first few weeks were trying to learn how the system works and know and manage personalities. Take the move to another country in the same manner as they moved a hospital. Arm yourself with all the skills you were trained in and brace for impact. It’s smooth sailing from there onwards.

Maroof International Hospital

Mr. Mustafa Javed Bhalli

Dr Mustafa is a leading orthopaedic surgeon in the twin cities of Islamabad and Rawalpindi. He is conducting very specialist procedures not routinely done in Pakistan. These include arthroscopy (key-hole surgery) of the knee, shoulder, ankle and hip.

He is an internationally accredited surgeon with FRCS degree in Trauma and Orthopaedics from the Royal College of Surgeons in the United Kingdom and obtaining a Certificate of Completion of Training (CCT) from the prestigious Yorkshire Orthopaedic Rotation Program. Following that he has been on a full time Orthopaedic Consultant Post in the National Health Service (NHS) United Kingdom. This constitutes to 16 years of overseas experience in the United Kingdom the United States and Europe.

Apart from his academic qualifications he is also a Health Executive MBA graduate from the Keele University in the United Kingdom.

He has been a member of various societies including the British Orthopaedic Association, British Elbow and Shoulder Society, British Orthopaedic Training Association. He is currently a member of the internationally renowned AO UK Trauma Society and a long-term member of the Yorkshire Orthopaedic Rotation Trainees.

Dr Mustafa completed his medical degree from Rawalpindi Medical College in 2002 and following this he moved to the United Kingdom where he underwent core and specialist training in various prestigious orthopaedic centres across the United Kingdom culminating to a satisfactory completion of orthopaedic training. Following that he underwent specialist training in joint replacements surgery, trauma and sports injuries and arthroscopy (keyhole surgery) training in centres of excellence in the UK the USA and continental Europe. These included the Mayo Clinic, Johns Hopkins University, and the San Antonio Orthopaedic Group in the USA.

During his training and as a Consultant in the UK, he has gone through various courses relevant to this work including joint replacement courses, trauma courses as well as general courses for effective communication skills and research methodology.

Dr Mustafa is also involved in education both locally and internationally. He is a member of the prestigious Chesterfield FRCS revision course and the Hull FRCS course in the United Kingdom where he is invited every year to teach trainees who are undergoing the FRCS exam. He is also an MRCS Examiner for the Royal College of Surgeons Edinburgh and conducted the first ever MRCS exam in Pakistan recently. He is also the International Surgical Advisor to the Royal College of surgeons Edinburgh for Pakistan.

He has a number of publications that have been published in international and local journals over the period of his service in the United Kingdom and Pakistan and he continues to strive to publish high-quality articles relevant to this field.

He is an excellent public speaker and has been invited to various conferences to present his work locally and internationally.

We would like to thank Mr Javed for his time and insight into orthopaedic excellence.

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Thumbs Up to Success: Mastering the CMC Joint An Interview with August 2023 — Mr. Alistair Jepson —

Mon, 14 Aug 2023 09:13:53 GMT

Thumbs Up to Success: Mastering the CMC Joint

An Interview with

— Mr. Alistair Jepson —

Issue 03, August 2023

Can you explain the role of the CMC joint in hand function and its importance for daily activities?

The thumb is anatomically unique when compared with the other digits of the hand. Not only does it have just two phalanges, but it also differs in having more freedom of movement and being able to work with, or against, the other digits (this is termed opposition).Opposition is what allows humans a greater ability to manipulate objects and perform actions such as pinching or grasping, when compared with primates and other animals. Consider opening a bottle or tying your shoelaces without your thumb and you quickly realise its worth.

The unrivalled dexterity of the thumb is derived from the joint at its base - the Carpo-Metacarpal (CMC) joint. This is often described as a saddle shaped joint because of its appearance of two saddles coming together at 90° angle. These two opposing surfaces give rise to its wide range of motion, but with pinch and grasp come high joint reactive forces – for example, a force up to 12 times greater in the CMC joint than at the tip of the thumb with pinch, and compressive forces of as much as 120 kg with forceful grasp. The thumb CMC joint, therefore, requires strong ligaments and tendons, working in unison, to maintain stability, as well as the unique bony architecture of joint.

What are the most common causes of CMC joint arthritis, and what symptoms do patients typically experience?

The thumb CMC joint is unfortunately a common site of osteoarthritis, being second only to distal interphalangeal joints in the hand. The reasons for this seem to be multi factorial:

Like other joints the incidence increases with age(significant increase over the age of 50)
High body mass index has a direct correlation.
Previous fractures and dislocations of the thumb predispose the thumb to osteoarthritis, as do.
Some occupations, especially those involving repetitive thumb movements, such as builders.

What is more unique though about the thumb is the fact that women are 10-20 times at higher risk of osteoarthritis than men; this disparity is thought to be due to a hormonal difference between the sexes which in turn affect ligament and joint laxity, with degeneration of the anterior oblique beak ligament of the CMC joint being the usual precursor of basal thumb arthritis.

Could you discuss the different treatment options available for CMC joint arthritis, including both surgical and non-surgical approaches?

The treatment that I would offer a patient would depend on their symptoms, their functional deficits, and the stage of their arthritis, with the Eaton-Littler classification being used to grade basal thumb arthritis.

Non-surgical management would always be first in mind, including activity modification, pain relief, splinting, and hand therapy. The next likely step would be an image guided joint injection with steroid, but in a younger patient I might offer a hyaluronic acid injection,, and some surgeons might offer a Platelet Rich Plasma injection.

Surgical options for thumb CMC joint arthritis are varied. Trapeziectomy, first described by Gervis in 1949 has become the most commonly performed operation over the years, with subsequent modifications to include ligament reconstruction with or without tendon interposition (the so called LRTI). Other options include fusion, resurfacing arthroplasty, silicone arthroplasty, and total joint replacement; each having their own advantages and disadvantages.

Trapeziectomy +/- LRTI was the procedure I was brought up with while training, but, like many other colleagues, I found the recovery to be long and unpredictable from this operation. I have also seen many younger patients referred to me with problems after trapeziectomy, predominantly issues with weakness of pinch and grasp, but sometimes also instability; such patents are incredibly challenging to treat with no good reliable surgical option.

This is why, for me, total joint replacement of the thumb CMC joint has become my operation of choice for basal thumb osteoarthritis; not only is recovery significantly quicker, but the restoration of strength and range of motion is much more predictable, and furthermore should complications develop I believe these to be easier to address.

Total joint arthroplasty of the thumb CMC joint has come a long way since the 1 ^st generation cemented implants of the early 1970’s (e.g., de la Caffinière® implant). Subsequent innovations have been to switch to uncemented implants with hydroxyapatite coated cups and stems (e.g. Arpe® and Ivory® implants), and now the current 3 ^rd generation implants have dual mobility, allowing better arc of movement, better stability, and reduced loosening compared to single mobility e.g. the Maia® and Touch® prostheses.

What types of imaging or diagnostic tests do you rely on to assess the condition of the CMC joint and determine the best course of treatment?

A recent set of plain x-rays of the thumb is essential, and where there is a concern on those x-rays about the height or width of the trapezium, or the presence of a large bone cyst or one of both sides of the joint, I would request a CT scan with 3D reconstructions.

Sometimes an MRI or USS can prove useful if there are concerns about another diagnosis, e.g., de Quervain’s or STT joint problems. I would point out though that should the STT joint appear radiographically arthritic then this would not necessarily exclude a CMC joint replacement, but it would mean usually further assessment was required with a diagnostic injection to determine if the arthritis was symptomatic or not.

How do you determine whether a patient is a suitable candidate for CMC joint replacement surgery?

I believe almost all patients who have failed non-operative treatment are suitable for a CMC joint arthroplasty with a few exceptions. The exceptions are where there is insufficient trapezium to secure the cup in the trapezium (standard trapezial cups are 9mm and 10mm, but 8mm cups are available for smaller trapeziums). Symptomatic STT joint would be another potential contra-indication, as would the fear of premature implant failure in someone with a very manual job, and there is some controversy about whether a CMC joint replacement should be done in a more elderly patient, given the high cost of the implant, and potentially osteopenic bone.

What are the main goals and expected outcomes of CMC joint replacement surgery?

A thumb CMC joint replacement differs from other options for treating basal thumb arthritis, in that it both preserves the length of the thumb and it provides an articulation which, whilst not saddle shaped, almost fully replicates the movement of the native thumb; hence strength and range of motion are maintained with a replacement. The inherent stability too of the dual mobility implant allows for an accelerated recovery, without the need for significant immobilisation, just a splint for comfort.

Rapid relief of pain
Quicker recovery
Better recovery of strength
Better recovery of mobility
Preservation of joint stability
Preservation of thumb length
Improved aesthetic appearance

Are there any alternative surgical procedures or techniques for CMC joint arthritis that you have found to be effective?

Prior to arriving on the Touch® and Maia® 3 ^rd generation implants I tried a number of other options in younger patients, including two types of hemiarthroplasty and one interposition arthroplasty, all utilising pyrocarbon. Some of these worked very well, but the results were not consistent, and the indications limited to a reasonably concentric joint i.e., no subluxation or dislocation.

The results from the 70+ replacements I have done over the last five years have been so good that I would not consider any other arthroplasty option presently.

How do you address patient concerns and manage their expectations when it comes to complex procedures?

A thorough balanced explanation of both the expected benefits of the operation and the possible risks is essential. Equating a thumb CMC joint replacement to an upturned microscopic hip replacement is usually the first part of my explanation, as this is something most patients will understand. The second part is to discuss recovery after surgery, time off work and likely time away from hobbies etc.

The specific risks I tend to explain in detail are:

Infection - this though is very rare for the thumb, and is certainly a lesser risk than with hip, knee and shoulder arthroplasty, presumably because of the different skin flora on the hand, compared with the skin flora of the axilla (for shoulder arthroplasty), and the groin (for hip and knee arthroplasty). I have to date had no deep joint infections, just one superficial infection.
Numbness - this is common due the close proximity of the superficial radial nerves – it fortunately resolves after about 2-3 months.
Instability and dislocation – I have had no cases to date.
Loosening - I have had no cases to date.
Intra-operative fracture of the trapezium - I have had no cases to date.
De Quervains tenosynovitis - I have had one case, which resolved with a steroid injection. Some colleagues I know routinely release the 1st dorsal tendon compartment during their surgical approach to avoid this complication.

Can you share some insights on the recovery process after CMC joint replacement surgery, including the timeline and rehabilitation exercises?

It is hard to accurately quantify the speed of recovery of a CMC replacement compared with a trapeziectomy, but I would estimate the recovery to be around 50% quicker. Most patients are already happy with their implant at their first review 2-3 weeks after surgery, and most can be discharged at 3 months post-surgery. Occasionally patients do take longer to recover, and I believe this is commonly due to pain and swelling, and other times patient compliance.

Are there any specific precautions or lifestyle modifications that patients should follow after CMC joint replacement surgery?

I would be very cautious about performing a CMC joint replacement in someone with a heavy manual job, and for the same reasons after a replacement I recommend avoiding repeated heavy tasks, but other than that almost no lifestyle modifications are needed.

How long do the results of CMC joint replacement surgery typically last, and are there any factors that can affect the longevity of the implant?

So far results have been published for single mobility implants for in excess of 10 years and dual mobility for nearing 10 years.

Are there any advancements or emerging technologies in CMC joint surgery that you find promising?

None I am aware of, but I anticipate implant choices will evolve to include the potential to make revision surgery easier; retentive cups are already available for instability with single mobility implants, a conical shaped cup is an option with the Touch® prosthesis, and I suspect other modifications of cup design will become available for revision surgery.

What advice do you have for patients who are considering CMC joint replacement surgery but may have concerns or fears about the procedure?

A thorough explanation of the operation and discussion about both benefits and risks is essential. I always explain to patients it is a relatively new implant and I can’t predict how long their implant will last but that it reasonable to expect theirs to last >10 years. Furthermore, if a patient was very anxious or undecided, I would put them in contact with a patient who had previously had the operation.

Can you discuss the importance of post-operative follow-up care for patients who undergo CMC joint replacement surgery?

Rehabilitation following a CMC joint replacement is an area where little has so far been published. In my own case I learnt a lot from the first replacement I did in 2018. Post operatively I immobilised the patient in a plaster backslab but within a few days of surgery the patient reattended saying they couldn’t bear the plaster and could I remove it, which I did with some trepidation, but I then witnessed the remarkable speed at which a patient with a CMC joint replacement could recover; consequently I have since stopped immobilising patients in plaster, I now just a soft wool and crepe for 5 days. The hand therapists then see the patient to make a thumb-based splint, which is worn for comfort and protection for perhaps 3-4 weeks.

Are there any specific patient demographics or characteristics that may influence the choice of treatment for CMC joint arthritis?

I would prefer to offer a thumb CMC joint fusion in a patient with a very physical job. I have previously alluded to age being a potential factor too.

How do you stay up to date with the latest advancements and research in the field of CMC joint surgery?

My first experience of CMC joint replacement was during a surgical visitation to Reims in France in April 2018. Very soon after that I performed my first case and since then I have performed 70+ replacements.

Despite 5 years’ experience I continue to advise all my patients that this is a moderately new procedure and that long term results are not yet available. I also strongly believe in data collection and understanding outcomes, so since starting I have collected outcome scores preoperatively and at 3 / 6 / 12 and 24 months post operatively (QuickDASH, VAS and EQ-5D scores).

I also strongly believe in education, and I have been invited as Faculty by LEDA on the Maia thumb CMC joint replacement course and I have also taught the fellows we have at Northampton as well as supporting consultant colleagues new to the procedure.

Finally, what inspired you to specialise in orthopaedic surgery, particularly in the treatment of conditions affecting the hand and upper limb?

The complexity and intricacy of hand & wrist surgery has always interested me, and I have been fortunate to have amazing mentors both during my training program in North West Thames and on fellowship, in the Brisbane Hand & Upper Limb unit and at the Pulvertaft unit in Derby.

About Mr Alistair Jepson

Mr Alistair Jepson is a highly trained and skilled consultant orthopaedic surgeon based in Northamptonshire. As a specialist in upper limb surgery, he provides professional and personalised surgical care for shoulder, elbow, hand and wrist conditions.

Mr Jepson graduated from the University of Birmingham in 1994. After this, he trained in and around London, with his orthopaedic specialist training taking place within the North West Thames region. He attained specialist accreditation in 2004 and then pursued his interest in upper limb surgery with two fellowships: the first being an upper limb fellowship at the Princess Alexandra Hospital in Brisbane, Australia (one of the largest and busiest upper limb units in the country) and the second being a hand fellowship back in the UK at the Pulvertaft Hand Unit in Derby.

His work is dedicated to providing the best possible outcomes for patients in both the public and private health sectors. What's more, his confident diagnostic skills are matched by his surgical expertise and meticulous explanations at every step of any procedure. His NHS practice is based at Northampton General Hospital, and privately he consults at the Three Shires Hospital in Northampton, the Ramsay Woodland Hospital in Kettering, and, by arrangement, at the Harley Street Specialist Hospital in London.

We would like to thank Mr Jepson for his time and insight into CMC joint replacement and overall contribution to the August edition of On The Podium.

To read more about Mr Jepson's practice visit upperlimb.co.uk

To download this issue of On The Podium , click below.

Forging a career path in upper limb orthopaedics, Shoulder2Wrist - Mr. Sam Vollans -

Tue, 04 Jul 2023 09:19:30 GMT

Forging a career path in upper limb orthopaedics:

Shoulder2Wrist

- Mr. Sam Vollans -

Issue 02, July 2023

Can you walk us through your career path and how you became interested in orthopaedic surgery?

Well, being from a completely nonmedical family, I was always interested in building things, and my first experience of doing that was building a rally go-kart during my GCSEs. I really liked welding and hammering and drilling and fixing things...…. making things work and work well. I wondered whether becoming a doctor was a good thing for me, as I enjoyed science, and I liked the idea that I could maybe make people better. I arranged some work experience with a friend of the family; I was only 15 at the time so I wasn’t allowed to go into theatre to watch surgery, but while I was in accident and emergency a doctor tapped me on the shoulder and said, “come with me!” He took me into theatre, and I watched a hip replacement – there were drills, hammers, cement, saws… it was heaven. I remember going home to speak to my dad, and I said to him that I wanted to do that as my job. He then worked out what A-levels I needed to do, what degree I needed to do, and ultimately my career into something called orthopaedic surgery!

What motivated you to specialise in shoulder & elbow surgery?

So I started my medical school training at Leeds University, knowing that I wanted to do orthopaedics, I went to meet the senior lecturer in orthopaedics at the time who was David Limb, who was a shoulder and elbow surgeon. I used to go and spend time with him in clinic on a Friday and learned a lot about shoulder and elbow surgery. I also performed a couple of course work pieces throughout my medical school degree in topics related to shoulder and elbow. I think his influence on me as a role model had a profound effect on me in choosing shoulder and elbow surgery. Throughout my orthopaedic training, I was struck by the amount of day case surgery and low inpatient volume of the surgeons that I worked with and that was another big positive for me. I also loved the huge variety of surgery within the upper limb, in contrast to lower limb arthroplasty for example. Though I have not lost my love of a big hammer, I enjoy the slightly more refined aspects of surgery on the upper limb.

Can you share any memorable experiences or cases that have had a significant impact on your career?

Sadly, most of the memorable cases that have a significant impact on your career are the ones that don’t go quite to plan. Every surgeon has a few of those in their career and we remember them well since we journey with the patients in their complications and their suffering. No surgeon wants to see their patients suffer as ultimately, we trained in a skill that should enable patients to get better. That said, I can also think of many cases that have gone just as expected or even better than expected. One such case was a lovely little boy, Alfie, who came to see me with a deformity of his arm, and he was very unhappy with the appearance of it and felt embarrassed and sometimes got bullied at school… he felt different to his friends. He was the first of several children to undergo a CT-planned patient specific instrumentation osteotomy of his arm to correct his deformity to perfectly match the other arm. It was amazing to see him walking to clinic with an arm that was healed, that was completely straight and with a big smile on his face. The surgery had completely transformed his life. These are the cases that I remember most vividly, when you remember that smile on the child’s face or the adult who is so thankful that you’ve been able to address their disability or issue. This is contrast of the lows and highs of surgery; it is at times both the most stressful and the most rewarding way-of-life.

Alfie before surgery

Alfie after surgery

What challenges did you face during your training, and how did you overcome them to reach your current position?

I think most challenges during training are related to learning how to behave as a senior doctor. It’s only over the last 5 to 10 years that the training systems within the UK and abroad have identified that the very best doctors undergo rigorous training in personal and professional development. In the past, we often modelled our behaviour on that of our trainers, which on occasions was less than ideal. I think my biggest challenge was working alongside and sometimes being trained by individuals who had very different values to mine. My transforming moment was when I realised that for many people in healthcare, it was just a job, NOT a way-of-life. There are many people in healthcare who do an amazing job, but they just do the job they are paid to do and no more. I always struggled with people not wanting to start early or finish late for the benefit of the patient. I now understand that personal life is incredibly important and ultimately far more important than my job. It’s a daily struggle to balance my work and personal commitments and I’m very blessed to have an incredibly understanding wife and three amazing kids that understand that I need to remain slightly flexible due to what I do. I couldn’t do what I do without them. Working within teams is fun and rewarding and it is through knowing your team that you can thrive and provide the patient with the very best outcomes.

As a specialist working in a major trauma centre, what are some of the most common types of traumatic injuries you encounter?

I’m working in Leeds in the North of England in one of the busiest major trauma centres in the UK. We encounter injuries not dissimilar to many other major trauma centres across the UK. However, the volume is incredibly high. I’m lucky to be part of a great team of sub-specialist orthopaedic trauma surgeons, who take a great interest in their subspecialty. For that reason, even though I do a general on-call, the injuries that I encounter on a regular basis are predominantly those of the upper extremity. I work from the sternoclavicular joint to the wrist, so common injuries (weekly occurrence) include clavicle fractures, shoulder dislocations and fractures, humeral shaft fractures, trauma around the elbow (distal humerus fractures, terrible triad injuries, monteggias etc), not to mention the forearm and wrist fractures. We also see a fair few sports related injuries requiring surgery including acute rotator cuff tears of the shoulder, pec major ruptures and distal biceps ruptures. These are common, so with the less common and then rare injuries included, one can see the varied nature of our trauma practice.

What are some unique aspects and challenges of working at a major trauma centre (MTC) compared to other healthcare settings?

Due to the volume and complexity of the work that we undertake and the huge team of multiple specialists that we can assemble, the most complex cases come our way and stay with us for the entirety of their care and follow up. This can be helpful for the patient as they have continuity of care and all their management under one roof. The difficult thing is that we often see accidents occurring in people who are travelling through our region or visiting from further afield. In these cases, we lose that continuity and multi-specialist support. We are hugely blessed in our MTC to have all specialists at our disposal, but in smaller hospitals this is not often the case and patients may have to travel between different hospitals for different aspects of their care.

The main challenge we face is balancing the urgency of our complex acute trauma surgery, and our planned less-urgent elective surgery. Due to bed pressures and limited theatre capacity, I frequently find myself having to cancel less urgent BUT equally important work, to prioritise acute trauma. When this acute trauma never stops, it makes it very hard to find the capacity to deal with planned surgery. In Leeds NHS we are lucky to have Chapel Allerton Hospital for the “not urgent” work which has more availability for this type of work. In addition, several patients choose to expedite their treatment through the private sector, and I have a relatively busy trauma and elective practice in both adults and children at the Nuffield Health Hospital in Leeds. They are very responsive to the urgency of some of the work we see in upper limb surgery. For the most complex planned non-urgent upper extremity surgery, where often two or even three consultants are required and patients want to avoid the long waiting lists, Leeds Teaching Hospitals also have self-pay packages available, which enables us to run theatres out of hours or at weekends.

Could you tell us about your current role and responsibilities within your orthopaedic practice?

Most orthopaedic surgeons have an oncall commitment, and for me that’s with the major trauma centre. This means I take in the most critically injured patients from accidents or crime. We work very closely with vascular surgeons who really are invaluable and frequently save people’s lives from internal or external bleeding. This makes my job slightly less stressful whilst working in this role. I really enjoy and value meeting the friends and families of patients that come into hospital under my care. Communication is one of the most important things that I value with my patients and their families. We have a motto in orthopaedics which is “save life, save limb, staged reconstruction”. This explains my duties when I'm oncall; when someone comes in with a complex leg injury my job is normally the first two and then I have some fantastic colleagues who can reconstruct legs. Almost all of my reconstruction work is in the arm region.

How do you address patient concerns and manage their expectations when it comes to complex procedures?

When we speak to patients about any surgery we discuss the benefits of the surgery and what we're trying to achieve to meet their expectations. For example someone might come to me with a stiff elbow and their expectation is that once i've done an operation for them their elbows should be back to normal and moving fully. The difficult thing is that often we know before we've even started that no operation will get the patient to a functional level that they're fully happy with and it's really important that we are realistic in our discussions.

Patients want a confident surgeon who knows what they can do and knows the outcome of their surgery but what they don't want is an optimistic surgeon who gives them false hope. That balance between confidence, positivity and realism is vital in the consultant-patient relationship. Following discussions about the benefits of surgery we always discuss the risks involved of such complex cases and there are many common risks that we encounter on a daily basis such as bleeding and infection but there are also rare risks that we see perhaps less than once a year such as a nerve injury. These are the risks that though rare have significant impact on the patient. It's very uncommon to encounter death as a result of planned surgery however some of the operations we do happen in Leeds within a major trauma centre because they do carry the risk of major haemorrhage and ultimately death. For example sternoclavicular joint reconstructive surgery comes with the inherent risk of major vessel injury and when performing these operations in children the risks are even higher. Once again i'm very grateful for my cardiothoracic colleagues that are always available on standby when we do these difficult operations; fortunately I've never had to call upon them from the coffee room!

The most important aspect of managing expectations is honesty and transparency. Patients really value conversations regarding unrealistic expectations and if discussed in a caring way and professional manner, they are far more likely to trust you as a surgeon. The referral practise that I have particularly in complex elbow means that I see the most complex patients from many hospitals around Yorkshire and they are often coming to me for a solution to the most difficult problems. It is not infrequent that we see problems we've never encountered before and we have to work as a multidisciplinary team to come up with a potential operative plan. We also discuss these cases nationally and internationally in various forums that we are part of.

In your experience, what are some of the most rewarding aspects of being an orthopaedic surgeon?

I think the most rewarding thing abo ut orthopaedics which was the thing that drew me towards it is that patients come in with a clear problem and we offer them a solution and to some extent it can be a quick fix. For example I have broken my wrist and therefore I went to hospital and had it fixed and now I am better. The reality is that the majority of cases are not simple like this but to some extent a patient has pain, stiffness or instability and our aim is to make them pain-free, mobile or stable.

Mr. Vollans with Formula 1 driver, George Russell

How do you achieve a work-life balance while managing the demands and responsibilities of a busy surgical practice?

This is incredibly challenging and changes throughout one's career. When you start a career in surgery you often think that you're the only person that your patients can rely on and you take the weight of the world on your shoulders. The reality is that there are many great colleagues that I have that cover my back and vice versa. There are times in one's life when family and personal responsibilities need to take priority and there are also times when your colleagues need to step back from various professional commitments for the sake of work life balance. Like all surgical specialties orthopaedics is a team sport and I'm very honoured to be part of a number of great teams in Leeds.

Just because I'm a surgeon and my wife is a teaching assistant it doesn't make my role in life any more important than hers. A simple rule that I've tried to adopt is - When I've had a bad day I always assume the person I'm speaking to had a worse day. I try not to talk too much at home about my job and in a way being from a completely non medical family background and not having any medics in my family, it's a great way to avoid talking about work at home. It doesn't mean I don't ruminate on difficult cases or complications.

We understand you were the first orthopaedic surgeon involved in arm transplant surgery in the UK. That must be such an honour, but what is your role in the team?

The Leeds Hand & Arm Transplant team is huge. It consists of many plastics & nerve surgeons, nurses, occupational therapists and physiotherapists. When we decide to put a patient on the hand transplant list they have gone through a long and rigorous selection process with the aforementioned team, as well as thought process including detailed Psychology input. My role is specifically in skeletal reconstruction and on occasions functional reconstruction of the tendons, muscles and ligaments. Looking at the imaging and the patient, we come up with a clear plan of how to put the donor limbs on the recipient and must ensure that we have the right implants available to perform the surgery at the drop-of-a-hat. You are right… it is a huge honour to be involved within this prestigious team. To see patients that previously had no arms picking things up and interacting with their environment again is very moving at times.

As an experienced surgeon, what advice would you give to aspiring orthopaedic surgeons who are starting their careers?

Who you are is more important than what you do! It was just before I started my consultant career in orthopaedics that I underwent some personal professional development and this revolutionised my consultant practise. Firstly, I realised that any orthopod can fix a difficult fracture; we are trained to do that and do it well. It is the way in which you handle yourself before, during and after the case that makes a surgeon world-class. Firstly, I learned that if I had the support of my team then I could conquer anything but without that, I was nothing. Most young surgeons go into consultant practise and get very excited about being the best at what they do, or perhaps bringing a different skill or surgical option to a big unit. They believe they are the leader of their team that will achieve such things. The reality is therefore that you cannot possibly lead without followers and it takes a long-time before others will follow you; it relies on trust, integrity and mutual respect.

I remember navigating this journey myself as a new consultant. I realised that I had to be able to influence those around me for the benefit of the patient. To do this, I had to know my team and understand what their drivers were. It's not good enough to tell the team they’re going to be working late for the sake of the patient… It's about involving the team in that decision, introducing them to the patient and showing them how grateful the patient would be if we were able to stay late and get their operation done. It's also about understanding the personal commitments of those within your team….. for example the nurse that you know that must leave at 5:00 PM to pick up their child from childcare. So, my advice is… know your team and know what drives them. By treating each member of your team as an integral part of it, you will gain their respect and be able to influence the way that they work for you for the benefit of the patient. This is the foundation of high performing teams… Good luck!

To read more about Mr Vollans' practice visit Shoulder2Wrist.com

To download this issue of On The Podium , click below.

On The Podium - Going Beyond the Scalpel An Interview with Dr. Sebastian Armida Beguerisse - June 2023 Issue 01

Thu, 11 May 2023 08:54:18 GMT

Going Beyond the Scalpel

An Interview with Dr. Sebastian Armida Beguerisse.

Issue 01, June 2023.

Can you tell us about your experience as an orthopaedic surgeon in Mexico and what drew you to this field?

Being an orthopaedic surgeon in Mexico is quite a dichotomy. I have a very diverse population with different cultures, beliefs, and lifestyles. As an orthopaedic surgeon, we must be able to treat young and old athletes and sedentary patients. Always looking for the optimal result in our patients, we must be empathic and know what they expect from us. I have a fellowship in Sports Medicine and Sports Surgery, and we have special training among other orthopaedic surgeons. When treating athletes, our focus is on early mobilization and return to sport. The use of casts is increasingly disappearing in favor of new and better treatments.

So, what drew me to the field? Well, personal experience. Around 2007, I was on my way to making the Olympic archery team. My trainer told me to focus on London 2012 rather than Beijing 2008. I used to train for three hours daily and then hit the gym for a couple of hours or even more. And before my young self knew better, I was clearly overdoing it and unfortunately injured my shoulder. I had to undergo surgery and lost momentum. Although my shoulder works perfectly, I never fully recovered my pre-injury level and had to say goodbye to the Olympics. But since then, I have been fascinated by orthopaedics and medicine. That is what drove me to go to med school in the first place, and I always wanted to become an orthopedic surgeon.

You have trained in various countries, including Spain with Dr. Alfonso del Corral, the former medical director of Real Madrid medical services. How have these international experiences shaped your perspective on orthopaedic surgery, and what lessons have you brought back to your practice?

Working with Dr. Alfonso del Corral was one of the best experiences. I got to learn first hand from one of the best orthopaedic surgeons in the world. This was one of my first real-world experiences treating professional athletes of the highest caliber. I learned many surgical techniques and in-office procedures which I still apply today in my practice.

A clear highlight is the percutaneous procedure for Achilles tendon rupture. Having remarkable results, I can say that I am one of the few surgeons in Mexico who knows and uses this procedure. And, might I add, most of the other surgeons who perform this procedure were taught by me. This was also when I learned about the use of orthobiologics. Since then, I completed a Masters on it and use them in some way or another in most of my procedures.

You have been involved in various research projects related to sports medicine and arthroscopy. Can you share any details about these projects and what you have achieved through them?

I cannot share many details on some of them since they are still ongoing! I have done research, especially on ACL injuries and their treatment. I was able to demonstrate that waiting at least a month while going to physical therapy yields better outcomes after surgery. This is quite important because many patients demand immediate treatment.

I can also talk about a research project regarding rotator cuff injuries in the working population. With this, we were able to determine what kind of jobs, other than those already described in past literature, were at a higher risk of having this type of injury. Since then, if I identify a patient in the risk group, my treatment always includes prehabilitation.

Can you discuss some of the different surgical techniques that you use when performing knee arthroscopy, and how do you determine which technique to use for a given patient?

There are many procedures we can now perform with arthroscopy. The first thing we need to know is what kind of injury we are dealing with. The most common ones found in the knee are ligament, meniscal, and chondral injuries.

In a broad sense, there are two things we can do with these injuries. We can perform a repair, in which we take the injured tissue and mend it either with sutures or ultrasound frequency. The second option is a plasty or replacement, which is mostly done on ligaments or chondral defects. To decide which technique to use, I must individualize the treatment for each patient. There is no one-size-fits-all approach. In most cases, we use a combination of procedures in different ways to achieve the best result.

What advice do you have for young orthopaedic surgeons starting out in the field?

This is a piece of advice I have given to many med students over the years. I always tell them that if they are going to lose sleep, they should do it at the cost of seeing their friends and family, not medicine or work. Medicine is a very demanding way of life, and it's easy to get lost in a study-work-sleep cycle. But family and friends are of the utmost importance if we are going to succe ed.

What are some of the most common sports injuries that you see in your practice, and what are some effective treatment options for these injuries?

There are a great deal of different injuries in orthopaedics. The most common ones I see in my office are sprains, strains, fractures, knee injuries, and shoulder injuries. Injuries that do not require surgery will almost always follow a similar treatment plan. The most important and current treatment involves a series of special exercises for the specific type of injury. I would also add non-steroidal anti-inflammatories, cryo or heat therapy. If I am treating a fracture, then we have to immobilize it for a determined period of time.

How do you balance the demands of your clinical practice with your other professional and personal commitments, and what strategies do you use to maintain work-life balance?

This is quite hard because the orthopaedic lifestyle is quite demanding. I do have scheduled times for consultations and surgery during the week and usually try to have the weekends off. But sometimes, time is not my own, and I can be called at any time for an emergency. Fractures and injuries do not wait for you. I have sometimes had to leave weddings or family reunions and get to the hospital ASAP. During my free time, I try to do as much as I can, including exercising and spending time with my family and friends. Occasionally, I try to get away from the city and relax for a few days. I would like to take this opportunity to thank my family and friends because they are very understanding of what I do.

What do you see as the biggest challenges facing the field of orthopaedic surgery in the next decade, and how do you plan to stay at the forefront of these changes?

There are two major challenges facing orthopaedic surgeons in the coming years. The first one is the great popularization of exercise. This is great, but it also means a significant increase in injuries. Some people don't realize they can go to an orthopaedic surgeon even before an injury and receive special tips, tricks, and prehabilitation treatments to prevent them. I have been trying to promote this for a while! The second challenge goes in a different direction, and that is the growing population with advanced age. This means that we will see an increasing number of degenerative diseases like arthrosis, massive rotator cuff tears, and fragility fractures. It is crucial that we come up with strategies that will help patients avoid these conditions.

What are some of the most promising advances in sports medicine and arthroscopy, and how do you stay up-to-date on the latest developments in your field?

The future has already caught up with us. As you may have realized from my previous answers, I'm a big promoter of prevention, even if it means fewer surgeries for me. One of the biggest advancements in sports medicine is genetic tests. Yes, like the famous "find your ancestors" tests, there are special tests you can take that will allow you to know what kind of injuries you are prone to. Knowing this is a game changer; we can help recreational athletes modify their routines and provide them with prehabilitation to avoid injuries. We can also assist high-yield and professional athletes in improving their performance with these tests. Another significant advancement in orthopaedic surgery is the use of robots during surgery to help the surgeon be as precise as possible. As of today, the robots on the market are primarily focused on knee, hip, and shoulder joint replacement. However, I can see in the near future that robots will become more specialized and used in all kinds of procedures. It is always important to stay updated with innovative technologies, techniques, and research. As one of my mentors used to say, "A doctor who stops studying is not a doctor anymore."

In your experience, how has the prevalence of ACL reconstruction versus repair changed over time, and what do you see as the future of these treatments for patients with ACL injuries?

In the past couple of years, we have seen a significant rise in the repair of ACL versus reconstruction. Although reconstruction still remains more prevalent, this shift is due to the type of injuries we commonly see in the ACL. Typically, an ACL ruptures around the mid-portion of the ligament, which is due to its anatomy and vascularization. For us to perform a repair, we need the rupture to take place in the proximal area of the ligament near the femoral insertion. Looking into the future, I hope to find the best ligament replacement. As of today, we have different grafts, either harvested from the patient's own body (e.g., quadriceps) or allografts from donors, and even some synthetic grafts. However, even in 2023, none of these options are perfect. I'm sure that in the near future, technology will catch up to our needs, and we will have a synthetic graft that prevents patient morbidity from the donor site. This graft should be strong enough to withstand the applied forces and should not cause any adverse reactions or damage to surrounding tissue and bone.

We would like to thank Dr. Sebastian Armida for his time and insight .

To download this issue of On The Podium , click below.

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Surviving and Thriving: A story of Resilience, Facing Life’s Greatest Challenges, and Transforming Orthopaedic Education. — Mr. Rishi Dhir —

Issue 10, August 2024

A Pioneer of wide awake hand surgery. An interview with: — Mr. Alistair Phillips —

Issue 09, April 2024

Putting Your Best Foot Forward: Insights from Foot & Ankle Specialist - Mr. Nikhil Nanavati -

Issue 08, March 2024

The CTC (“Closing the Circle”) Technique An Innovative approach to treating AC Joint Stabilization. An Interview with Ana Catarina Ângelo, M.D.

Issue 07, February 2024

Innovating Hip Replacement Surgery: With Professor Paul Lee December 2023 — The SPAIRE Technique —

Issue 06, December 2023

Inspiring Orthopaedic Leaders: Educational Excellence in Orthopaedics October 2023 — Mr. Fazal Ali's Story —

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From the NHS to Pakistan: Orthopaedic Excellence Knows No Borders September 2023 — Mr. Mustafa Javed —

Issue 04, September 2023

Thumbs Up to Success: Mastering the CMC Joint An Interview with August 2023 — Mr. Alistair Jepson —

— Mr. Alistair Jepson —

Issue 03, August 2023

Forging a career path in upper limb orthopaedics, Shoulder2Wrist - Mr. Sam Vollans -

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Issue 02, July 2023

On The Podium - Going Beyond the Scalpel An Interview with Dr. Sebastian Armida Beguerisse - June 2023 Issue 01