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Belfast, United Kingdom

Ball E.M.A.,Queens University of Belfast | Gibson D.S.,University of Ulster | Bell A.L.,Musgrave Park Hospital | Rooney M.R.,Queens University of Belfast
Lupus | Year: 2014

Objective: The objective of this paper is to elucidate the role of specific cytokines in lupus (SLE) arthritis. Methods: Fifty SLE and 40 RA patients had an ultrasound (US) scan of their hand as per standardized protocols. US scores were expressed per joint and as a total 'US activity' score, (sum of power Doppler (PD) and grey-scale synovial hypertrophy scores in all joints) and a total erosion score. SLE disease activity was assessed (BILAG and SELENASLEDAI). Plasma levels of IL-6, TNF-alpha and BLyS were measured using sandwich ELISA kits (Quantikine kits, R & D). Results: On the basis of the US results SLE patients were divided into three groups: erosive arthritis (n=20), non-erosive arthritis (n=18) and those with a normal US scan (n=12). Across the SLE groups plasma IL-6 levels correlated with CRP (p<0.001), hand deformity scores (p=0.005), BILAG musculoskeletal score (p=0.009), wrist PD score (p=0.01), the presence of tenosynovitis (p=0.008) and total US activity score (p<0.001) (which remained constant when corrected for total BILAG score). Neither TNFalpha nor BLyS levels correlated with US or clinical measures of lupus arthritis; however, TNF-alpha correlated with total BILAG score (p<0.001). Conclusion: This is the first study to examine levels of specific cytokines in a cohort of SLE patients stratified in terms of joint disease by US, where the most significant finding is that IL-6 levels correlated both with clinical and US measures of arthritis disease activity. © The Author(s), 2013.

Hanson J.R.,Musgrave Park Hospital
Scottish Medical Journal | Year: 2010

A description of the current state of sports pre-hospital immediate care training for pitchside doctors and physiotherapists in the United Kingdom. The background and development of such courses is covered, as are the major skills and revalidation procedures. Course credibility through professional regulation and instructor selection is discussed, as are the differences between the sports pre-hospital courses and traditional in-hospital resuscitation and trauma courses. Official policy from the Faculty of Sports and Exercise Medicine in the UK is considered and recommendations for change suggested.

Sonnery-Cottet B.,Center Orthopedique Santy | Mogos S.,Center Orthopedique Santy | Thaunat M.,Center Orthopedique Santy | Archbold P.,Musgrave Park Hospital | And 4 more authors.
American Journal of Sports Medicine | Year: 2014

Background: Physicians should consider an increased posterior tibial slope (PTS) as a risk factor for graft failure when proposing anterior cruciate ligament (ACL) re-revision.Purpose: To describe the surgical technique of combined ACL revision and proximal tibial anterior closing wedge osteotomy and to evaluate its clinical outcome in cases of recurrent graft failure with associated increased tibial slope.Study Design: Case series; Level of evidence, 4.Methods: Between 2008 and 2010, 5 combined ACL re-revisions with proximal tibial anterior closing wedge osteotomy were retrospectively evaluated after a mean 31.6 months follow-up (range, 23-45 months). All patients reported subjective knee instability preoperatively and demonstrated increased laxity on physical examination. Intrinsic risk factors for graft failure (excessive tibial slope) were identified in all cases. Preoperative and postoperative functional assessments included the International Knee Documentation Committee (IKDC) score along with the Lysholm score and Tegner activity scale.Results: The mean Lysholm score was 46.2 preoperatively (range, 26-69) and 87.8 (range, 60-100) postoperatively. The mean IKDC subjective score was 39.5 (range, 21.8-64.4) before surgery and 79.1 (range, 48.3-98.9) at the last follow-up. The mean Tegner activity score was 7.4 (range, 5-9) before the latest ACL injury and 7.2 (range, 5-9) at the last follow-up. The mean PTS was 13.6° (range, 13°-14°) preoperatively and 9.2°(range, 8°-0°) postoperatively (P=.0005). The mean differential anterior laxity was 10.4 mm (range, 8-14 mm), and this significantly decreased to 2.8 mm (range, 2-4 mm) at the last followup. Using the Kellgren-Lawrence classification to evaluate the presence of arthritis, 1 patient was grade 1, 3 patients were grade 2, and 1 patient was grade 3.Conclusion: Combined ACL re-revision with proximal tibial anterior closing wedge osteotomy restores knee stability and function with satisfactory clinical outcomes in patients who experience recurrent ACL ruptures with an associated increased PTS. © 2014 The Author.

Sonnery-Cottet B.,Center Orthopedique Santy | Archbold P.,Musgrave Park Hospital | Rezende F.C.,Center Orthopedique Santy | Neto A.M.,Center Orthopedique Santy | And 2 more authors.
Arthroscopy Techniques | Year: 2014

Intense interest has focused on the recent description of the anterolateral ligament of the knee. Advancing knowledge of its anatomy and function is leading to a realization of its importance in the rotatory control of the tibia in anterior cruciate ligament injuries. Reconstruction of this structure will increasingly become an important goal during anterior cruciate ligament reconstruction. However, preoperative assessment of this ligament is difficult. Clinical assessment of rotatory laxity has poor reproducibility, and it is difficult to define using current imaging techniques. This article is the first to describe a safe and reproducible arthroscopic technique to allow identification and examination of the anterolateral ligament of the knee. With the knee at 90° of flexion, the arthroscope is introduced through the anterolateral portal to allow clear visualization of the lateral gutter. Under direct vision, an accessory portal is made over the inferior limit of the lateral gutter. A shaver is then introduced through this portal and used to debride this synovial recess and define the anterolateral ligament. This allows the surgeon to examine the integrity of the anterolateral ligament, in particular its femoral insertion. If required, this additional information can facilitate the performance of a more accurate and effective extra-articular reconstruction. © 2014 Arthroscopy Association of North America.

Ball E.M.A.,Musgrave Park Hospital | McKeeman H.M.A.,Belfast City Hospital | Patterson C.,Queens University of Belfast | Burns J.,Musgrave Park Hospital | And 6 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Background: Plantar fasciitis is a common cause of heel pain. The aim of this study was twofold: to compare steroid injection with placebo injection and to compare ultrasound guided with unguided steroid injection in the management of this condition. Methods: 65 patients with inferior heel pain were recruited between November 2008 and June 2011. Heel pain was measured using a visual analogue scale (VAS) at baseline and follow-up 6 and 12 weeks after injection. Results: 22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p=0.018 and p=0.004, respectively). There was a 19.7 (95% CI 2.5 to 37.0) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a 24.0 (95% CI 6.6 to 41.3) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was 25.1 (95% CI 6.5 to 43.6) and 28.4 (95% CI 11.1 to 45.7) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups ( p=0.00). Conclusions: In this study, steroid injection showed a clear benefit over placebo at 6 weeks and this difference was maintained at 12 weeks. Trial Registration No ISRCTN79628180 (www.controlled-trials.com).

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