Annual Meeting of the Biological Knee Society, Old Trafford Football Stadium

kneesociety logo

The Biological Knee Society was set up by like-minded knee surgeons to promote awareness about the a-la-carte biological options available to preserve function in knees. The meeting served as a great conduit for biological knee surgeons to discuss current literature, techniques, research, innovation and the future of biological knee interventions.

The meeting comprised lectures and live surgical demonstrations from the Arthrex mobile lab on site – with a great demonstration into a growing trend in ACL reconstruction – the use of quadriceps as a graft. Mr Guy already uses Quadriceps in some primary and revision ACL reconstructions. The main themes to the day were the anterior cruciate ligament (ACL), the use of biologics in the knee, articular cartilage repair, meniscal repairs and transplantation and the use of software to collect patient and surgical data / outcomes.

Even though the meeting is for knee ‘surgeons’ it must be said that many of the options discussed at the meeting were injectable techniques to improve local biology and the use of the already established PRP (Platelet Rich Plasma), nSTRIDE (Autologous Protein Solution) and Lipogems.

Link to the B.K.S.

Pitch-side view of the technology used to make sure the grass is kept under optimal conditions despite the ‘inclement’ weather Manchester is also famous for!

London Knee Osteotomy Masterclass

An effervescent international faculty were involved in the delivery of the first osteotomy masterclass in London. Mr Guy has previously visited the original site of the Osteotomy Courses in Basingstoke and more recently in Newcastle. The course was well choreographed by Prof Adrian Wilson, Ronald Van Heerwarden and Rags Khakha.

The masterclass provided a valuable update into the ever expanding role of osteotomy in the knee. As a sports knee surgeon Mr Guy has used osteotomies around the knee to correct chronic ligament injuries and also to treat early arthritis in the young or high-demand patients as an alternative biological procedure to avoid joint replacements.

Highlights to the meeting were the live surgical demonstrations of simple to complex osteotomies, biological slope changing osteotomies, intra-articular osteotomy, the use of ‘golden’ wires to prevent far cortex fractures, the role of ACL failure and tibial slope and the pragmatic session on managing complications!

Regenerative Cartilage Meeting, Lords Cricket Ground

Thomas Lord Conference Centre

Mr Guy attended an international meeting held in the glorious home of English Cricket. More importantly – did you know that Thomas Lord was a Yorkshireman born in Thirsk!?

The meeting covered a lot of the basic science and evidence for biological treatments around the knee. Surgeons and scientists from around Europe discussed the outcomes from multiple surgical techniques to improve the biological response from surgery and the use of STEM CELLS using micro-fragmented adipose tissue / LIPOGEMS system. More information can be found about lipogems here

Cell Therapy for Knee Articular Cartilage

Treatment of symptomatic cartilage injuries can be complex. There are many treatment modalities available (see website). With the advent of new NICE (clinical guidelines) we are now available under strict circumstances to apply to provide cell therapy. Cell therapy is not a new concept and first generation techniques have been around now for over 30 years. Mr Guy had the distinct pleasure of meeting one of the pioneers of cell therapy, Prof Mats Brittberg from the University of Gothenburg at a cartilage meeting in London.

Cell therapy is the process whereby cartilage cells are harvested from the knee with keyhole surgery (biopsy). The cells are then processed in a lab increasing the number of cartilage cells and then approximately 4-6 weeks after harvesting they are ‘seeded’ inside a knee during further surgery.

A seminal article in the New England Journal of Medicine by Prof Brittberg can be found here about treating cartilage defects.

Prof Brittberg and Mr Guy discuss Cell Therapy in London

PCL injury in a football player treated with a ‘PCL Jack Brace’

The PCL (posterior cruciate ligament) is the largest ligament in the knee and is injured less frequently than the ACL (anterior cruciate ligament). The classic mechanism for a PCL injury is a large force going through the front of the shin bone (tibia) in a bent knee. This is sometimes called a ‘dashboard’ injury when a car rapidly decelerates and the bent knee hits the dashboard and snaps the PCL. When a sportsperson suffers a PCL injury they need urgent specialist management to decide if they need an operation or whether they can have non-operative treatment such as a ‘Jack Brace’. Early definitive diagnosis and treatment will ensure the best outcome. The PCL Jack Brace is specially designed and engineered to provide appropriate support to a PCL that will allow it to heal to avoid an operation.

The following case report highlights how some knee injuries on the sports field can be catastrophic for a knee even with an innocuous mechanism of injury. This link has a case report of a football player referred to Dr Power and Mr Guy who was successfully treated and with accelerated rehab went back to playing quickly. The injury occurs on the video approximately one minute into the football game. The second link is to other athletes who have been treated by my collegue Mr Williams of the Fortius Clinic using the ‘Jack Brace’.

Video and story of footballer:

Links to other professionals treated with a ‘Jack Brace’:

Knee Discussion Club

The Knee Discussion Club is an invite only event for knee surgeons in the UK hosted by Mr Anand (Manchester) and Mr Lavelle (Fortius) taking place over 2 days in the UK. Many opinion leaders from the UK were present. This was a great opportunity to update and share current knowledge about biological knee treatments. The event was organised by Innovate Orthopaedics and Joint Operations.

Yorkshire Sports Knee Meeting

Mr Guy organised and chaired another fantastic meeting of Knee specialists from the Yorkshire region. We are grateful to Joint Operations for their kind sponsorship of the event. We had a large turn out of specialist knee surgeons with a broad skill set. Pure sports knee surgeons, surgeons with major trauma and limb reconstruction experience, paediatric knee surgeons, senior academic physiotherapists and senior knee fellows.

The venue was an amazing private dining room that was housed in Iberica, Leeds. (Highly recommend the food and the gorgeous venue). We presented some high-quality, complex / unusual / rare / knee cases that were all discussed for the benefit of patient care. Mr Guy had managed to capture earlier in the day video footage of the exceptionally rare ‘snapping biceps femoris’ syndrome and with the patients permission was shown and discussed. Also Mr Guy presented some complex biological knee reconstruction of failed knee ligament surgery requiring re-aligning the knee with an osteotomy and at the same time using donated allograft tissue (dead donated American’s!) to revise and rebuild new ligaments and also a custom sculpted bone graft made from a donated femoral head. The patient was back at work in a physical job at 6 weeks!

We look forwards to the next knee meeting in October 2018.

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