On November 20-21 2017 there was an excellent event - the Warwick Sports Knee meeting at St. George’s Park.
Tim Spalding and Pete Thompson run their Warwick Sports Knee Conference every alternate year and it's quite rightly considered to be the premier knee congress in the UK. They both spend significant time thinking about the most important topics that knee surgeons and the knee community want to hear about in terms of innovation, and also provide a platform for surgeons to understand the fundamentals and basics of knee surgery in terms of anatomy, biomechanics, and the bread-and-butter procedures for primarily soft tissue issues.
The course is always comprehensive in starting with biomechanics and anatomy and then leading the delegates through the different aspects of soft tissue knee surgery.
There is always a significant amount of preparation work that goes on in the background, though they take the unusual step of contacting all of the Faculty and specifically asking them to focus their attention on certain aspects of their chosen subjects such that there isn't overlap and any important aspects of their chosen subject are highlighted during the talk.
There is a 'three-line-whip' that no-one overruns their allotted time, so that we can always make use of the discussion time, which again is key to making this course unique.You can see from the programme that they had some of the leading knee surgeons globally speaking at the meeting. The particular star was Rob LaPrade from Vail who did a beautiful presentation on the collateral ligaments of the knee, and their anatomy and how to reconstruct them.For me the highlight was the ACL repair section where I worked with Tim and Pete getting a group of surgeons together who were considered to be world experts on the subject of ACL repair.
I did my presentation on the paediatric indications and an overview of the paediatric ACL injury, and how I feel repair plays such an important role, presenting in my dataset 100% success with no revisions with a significant number out beyond two years.
We had an excellent presentation from Greg DiFelice from the Hospital for Special Surgery. Greg has pioneered a slightly different way of doing repair, but it is really a variation on a theme and he has led the way in terms of publishing on ACL repair with over 15 papers on this subject over the last two years. Greg presented the history of ACL repair and explained that although it acquired a bad reputation if you look back over the historical papers where there was only 50% success and you drill into those patients you see that Type I proximal avulsion group actually had a very high success rate within the overall ACL repair cohorts. So if we went back and looked for instance at Feagin or Marshall's papers on ACL repair, their Type I's actually had a very high success rate - and sadly that observation was missed, so all ACL repairs were lumped together (the Type I's through to the Type IV's) and really this in adults works best in Type I tears. Greg did show that as his skills had improved he could take on more and more challenging cases with great success, and the number of ACL repairs that he is now doing has risen exponentially as a result of his work and his expertise.
Jurgen Barthofer did a wonderful job of presenting a large series of ACL repairs in adults, and gave some excellent tips on how to carry out the procedure and make it effective and successful. Martha Murray, who is a world-renowned scientist who has been carrying out her BEAR study for the last decade, presented her work. She put us all to shame when she showed over 100 contributors to the research which has been funded by multi-million pound research grants, and is showing with her scaffold excellent results in the Type I injuries that they have been treating. Gordon MacKay led the discussion and chaired the session, and overall we really I think were able to give a very balanced view of ACL repair and where we are going with it.
Romain Seil, the ESSKA president, did point out that we need to proceed with caution as we've had a proposed method of treating ACL rupture with the Ligamys system, and sadly this has failed and is causing major problems in terms of revision surgery. I think that it is important to know that we are comparing apples with oranges and that ligament system involves the use of a large metal spring which is placed in a fairly large-diameter tunnel in the tibia, and is a totally different proposition to what we have been proposing, and sadly it has not been successful and removing the spring has been a major problem. The ACL repair techniques that we proposed are all minimally invasive and use a totally different philosophy with a FiberTape internal brace support for the majority of cases, Greg using anchors within the knee and Martha Murray using a scaffold.
It was an excellent two day course and on the second day I was involved in an anterolateral ligament versus lateral tenodesis debate with Andy Williams, which was really very measured and I think we are all on the same page now feeling that a lateral procedure is an important thing to do for patients undergoing revision ACL surgery or in high risk groups such as children or hyper-lax patients or sportsmen. We both made arguments for our different procedures and I think ended up pretty much on the same page with what I think is just a variation of a theme.It was a a great pleasure to be invited to be on faculty and I can't commend Tim and Pete enough for the work and effort put into the course and the great success story that it was.