Knee Surg in London @kneedoclond Twitter profile

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Knee Surg in London

@kneedoclond

1 year

1/2 Working diagnosis on underlying pathology in this knee...???? #orthotwitter #FloppyKneeIssues #RevisionReconstruction1

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Knee Surg in London

@kneedoclond

1 year

@DavidMosley1 ..or else I was using the video for educational purposes, with a clear cut, documented management plan discussed with patient in an outpatient setting, which recognised his issues…????? Wasn’t ACTUALLY asking for surgical advice from Twitter, but I do accept I was unclear.

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Knee Surg in London

@kneedoclond

1 year

Much as my focus is knee sports med and joint preservation, every now and then one has to accept that TKA is the way forwards…..particularly with a Medial Pivot design. And yeah, I resurface the patella…. #orthotwitter #Patient Choices.

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Knee Surg in London

@kneedoclond

2 years

Mrs MSK radiologist been asked to carry out an ultrasound to see if LCL is damaged in this patient. She kindly sent plain films for perusal. Request came from an orthopaedic surgeon. Not much one can add…… 😖 #orthtwitter #TKA revision #ProfoundInstability

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Knee Surg in London

@kneedoclond

2 years

EUA pre revn-ACL, medial meniscal allograft transfer, lateral meniscal root repair and lateral extra-articular tenodesis. This degree of laxity cannot be corrected by ACL reconstruction in isolation… #acl #kneeinstability #orthotwitter

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Knee Surg in London

@kneedoclond

2 years

Another case of a patient being conned into PRP injection and spending 💰💰with no gain. MRI was obtained by the “ortho expert” who injected….who files into London from Munich regularly to treat with the “magic needle” #orthotwitter #EvidenceBasedMedicine #SnakeOil

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Knee Surg in London

@kneedoclond

8 months

Offered stem cell injections last year in London, for end-stage arthrosis….. Cost mentioned was 5 figures. When will we be able to report snake oil salesmen to the governing authorities..? #orthotwitter #TKA #UnprofessionalConduct

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Knee Surg in London

@kneedoclond

3 months

13 years ago, Mrs MSK Radiologist welcomed me into her family….. What a privilege to have been so included. #HinduWeddings #Verona #orthotwitter

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Knee Surg in London

@kneedoclond

1 year

2/2. 2 Prior failed ACL reconstructions Medial and lateral meniscal deficiency. Staged reconstruction with bone grafting to non-anatomical tunnels, followed by ligament revision reconstruction and meniscal allograft

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Knee Surg in London

@kneedoclond

4 years

Sometimes when you see a patient sent to you for an ACL revision, the reason for the failure is not hard to identify.... not entirely certain the tibial ACL footprint sits in the same place as the tunnel...😳

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Knee Surg in London

@kneedoclond

4 years

3 year duration of progressive weakness ankle dorsiflexion and altered sensation dorsum of foot

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Knee Surg in London

@kneedoclond

5 years

Ah the joys of finding and freeing the common peroneal nerve in the chronic big knee injury, with massive disruption on the lateral side... and the joy of the foot moving post op in recovery.. Who would be a peripheral nerve surgeon for a living...?😰

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Knee Surg in London

@kneedoclond

2 years

1/3. Antero-Lateral ligament reconstruction in relation to ACL recon. Many differing techniques, but initially identify anatomy related to lateral epicondyle & Segond point. I carry this out after ACL graft harvest & prior to intra-articular work. Allograft utilised here

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Knee Surg in London

@kneedoclond

2 years

Soooo. Patient popped over from Florida for a further opinion, having had a poor result from bilateral knee arthroscopy. Left mild gain, right no change.V limited ROM hips, with pain, esp right. You cannot make hip DJD resolve with knee arthroscopy.. 😖 #orthotwitter

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Knee Surg in London

@kneedoclond

1 year

🧵1/4 Medial knee DJD in woman in mid-40's, with BMI 38. Pain limiting activities and generating difficulty with working. Failed non-op Mx & been discussing options for over 12/12 in clinics.. #orthotwitter #osteotomy #KneePreservation #ApexScrew

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Knee Surg in London

@kneedoclond

4 years

Chronic lateral knee pain in active 41 male, some years post lateral meniscectomy. Mild valgus pre-distal femoral osteotomy. DFO and complete resolution of knee pain plus increased activity levels. Osteotomy is a powerful tool in our kit bag. #jointpreservation

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Knee Surg in London

@kneedoclond

3 years

Last 10 ACL cases 4 revision One QT 5 BPTB Rest isolated ST autograft 9 with lateral augmentation 5 lateral root repairs 2 ramps 3 probably need medial MAT at later point…. Where did the slam dunk cases go..? Asking for a friend, obvs 🙄🥵 #orthotwitter #ACLFest

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Knee Surg in London

@kneedoclond

8 months

I SSsoOoooO wish that I could be remunerated based upon the implants that I used….especially with meniscal allograft surgery 🙄🙄 #orthotwitter #jointpreservation #MeniscalAllograft

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Knee Surg in London

@kneedoclond

2 years

@jointdocShields Yep….. never trust any medic/surgeon who claims they have “never had a complication” 1. They have never done the procedure 2. They are lying to you 3. They are lying to themselves 4. They have no experience to reflect upon, when crap happens. Choose your explanation…

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Knee Surg in London

@kneedoclond

2 years

Sometimes the venue and associated view can make the early morning coffee taste a little bit better. #EnjoyTheVenue

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Knee Surg in London

@kneedoclond

2 years

@generalorthomd Not sure that actually constitutes a “complication” Lego Man….. But as they say, if “you haven’t had a complication, then you just haven’t done enough of them yet”. Thanks, as ever, for sharing AND for all the amazing work you do for your patients…. Have sent you a DM.

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Knee Surg in London

@kneedoclond

2 years

Does white wine and Doritos constitute a balanced evening meal, when Mrs MSK Radiologist is visiting family..? Asking for a friend, obvs. Wine has a cork rather than screw top, if specifics required.

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Knee Surg in London

@kneedoclond

1 year

6/12 post Rt QT ACL and LCL recon + ALL & meniscal repair. Coronal “wobble” on initial single leg stance, but good muscle regeneration.. V focused patient, but still about a month 2 go before ⬆️ running. With pt permission #orthotwitter #KneeRecon #HardYards

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Knee Surg in London

@kneedoclond

1 year

What better way to celebrate the achievements of hip colleagues Marc G and Marcus B, as they leave Guy’s Hospital, after many years of service.. Great wine list organised by ⁦ @andy_shoulder ⁩ ⁦ @mbankes ⁩ #CelebratingGr8Colleagues #orthtwitter #NHS

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Knee Surg in London

@kneedoclond

11 months

Always need a careful and considered consultation when a medical colleague comes along with a poorly functioning ACL reconstruction… Not a typical “anatomical tibial footprint” #orthotwitter #ACLRevision #aclreconstruction

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Knee Surg in London

@kneedoclond

7 months

Use of allograft soft tissue patch to gain soft tissue closure with unexpected skin loss, in an acute setting…. #OrthoTwitter #MerryChristmas

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Knee Surg in London

@kneedoclond

8 months

When it’s been a tough few weeks, then a quiet night at home with Mrs MSK Radiologist needs to be celebrated. #orthotwitter #CelebrateTogetherness Thursday is the new Friday… 🥳🍷

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Knee Surg in London

@kneedoclond

2 years

4/4 With patient permission.. 7 weeks post op and just about to come up to FWB….great ROM, at this point, thanks to patients focus and hard work….. Long way to go, but hopefully he has the best knee we can give him…. Team work, gets it done….but it’s a long road.

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Knee Surg in London

@kneedoclond

2 years

1/6 Warning: operative pictures. #orthotwitter #KneeDisruption #KneeInstability 32 years of age, forced varuss instability playing raquet sports.... Pain, swelling and persistent instability. Ref for further opinion 10/52 post injury... CP Nerve dysfunction (improving)

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Knee Surg in London

@kneedoclond

4 years

@LorraineMHickey @OrthopodReg Really nice double handed forehand technique........ Always nice to see that quality of hand-eye co-ordination in theatres.... and just remember kids, “orthopaedics is a contact sport”

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Knee Surg in London

@kneedoclond

1 year

Just please stop…….. Please.

Luke Todd

@PhysioTodd

2 years

I’m always amazed how people have the nerve to talk utter nonsense with such confidence when they are selling something

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Knee Surg in London

@kneedoclond

3 years

@mswami001 Seemed appropriate to add in this message, that has been doing the rounds, in response

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Knee Surg in London

@kneedoclond

2 years

@generalorthomd @Davembmd @DrJP_13 @jointdocShields @CenterRotation @InvictaOrtho @OrthoTwiter @northwoods1980 @ChipRoutt @LadyInterlocks Twitter is such a positive environment, from my perspective….. True there are some out there who are negative and troll, but “ Hater’s gonna Hate” as we all know. There are some simply AMAZING colleagues who bring their experiences, to help and educate. #orthotwitter 🥳🤩

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Knee Surg in London

@kneedoclond

5 years

Fascinating (and alarming) talk from @goldstone_tony as to pension and tax liability, given at GSTT. Was not aware true impact pension taper to all senior medical staff until now and sobering to realise how it will change working patterns across the board....

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Knee Surg in London

@kneedoclond

2 years

4/4 3 weeks post-op, with clinic check radiographs of plate, with bone graft and video of patient early ROM. With patient permission... Next comes medial meniscal allograft transfer and plate removal, once CT demonstrated bone graft incorporation........

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Knee Surg in London

@kneedoclond

3 years

Dear #orthotwitter if you are carrying out a revision ACL reconstruction and decided to just use divergent fresh drill holes in tibia and femur, please think of the next surgeon re-revising and facing tunnel confluence & marked bone loss. Message ends. 😳🤬🤯 #BoneLossManagement

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Knee Surg in London

@kneedoclond

3 years

NHS Team at Guy’s Hospital. Privilege to work, learn and educate with great colleagues from around the World. We face pandemics, terrorist events and all challenges together. We are the NHS of today & tomorrow. We are London.. @NHSuk @GSTTnhs London SE1

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Knee Surg in London

@kneedoclond

2 years

1/5 TKA in prior ligament reconstruction Progressive arthrosis some years post ACL, PCL and MCL reconstruction in active 53 year old, unresponsive to non-op Mx #orthotwitter #kneereconstruction

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Knee Surg in London

@kneedoclond

1 year

I note the company spokesperson comment for SpaceX Starship as having undergone “rapid, unscheduled disassembly” It is my intention to henceforth use this phrase 2 explain the events within the knee, during multiligament injury. #orthotwitter #kneeinjury

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Knee Surg in London

@kneedoclond

2 years

Another day in NHS knee clinic, looking at CHRONIC ACL deficiency cases…as they are the only ones that seem to exist 😳🙄 Mean timeline from initial injury, to being diagnosed and a management plan being started….4 years and 10 months… most “acute injury “case occurred in 2019

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Knee Surg in London

@kneedoclond

2 years

Lovely evening to be walking over London Bridge……

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Knee Surg in London

@kneedoclond

4 years

Revision ACL pathway can be long.... 3 weeks post UTO to offload medial compartment and reduce slope. Tunnels bone grafted. Able to single leg squat already. Next; med meniscal allograft & QT rev ACL + LET... Long journey with our patients. Patient permission given

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Knee Surg in London

@kneedoclond

2 years

With patient permission.... Ant-Med tuberosity + hint of distalisation & gracilis auto MPFL recon.. Instability abolished. Feels stable. BUT still a way to go 2 eliminate quads lag & optimise. Post-op is tough...need to state that pre-op #orthotwitter

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Knee Surg in London

@kneedoclond

1 year

What a fantastic day to be in the Scottish Highlands, enjoying the scenery. Makes the miserable days more tolerable…. #orthotwitter #TheGreatOutdoors . Sun coming up near Loch Ness…

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Knee Surg in London

@kneedoclond

1 year

A very modest interior for a meeting dinner….. Catching up on old friendships, while talking about Knee Optimisation. #OldSchoolLondon #BASK2023 #orthotwitter #LondonLife

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Knee Surg in London

@kneedoclond

5 months

Double level osteotomy, or go home…..?????? For when you need that big correction……. #orthotwitter #jointpreservation

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Knee Surg in London

@kneedoclond

2 years

1 of 4. Previous extensive lateral sided injury posted, now with updates. Warning of surgical slides..... #orthotwitter #ComplexKneeReconstruction

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Knee Surg in London

@kneedoclond

2 years

2/4 Increased tibial slope along with varus tibial orientation. Tibial tunnel expansion. Plan: single stage tibial osteotomy, with correction both sagittal and coronal orientation, with use of patient specific guides with NewClip osteotomy plate. Bone graft tibial ACL tunnel

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Knee Surg in London

@kneedoclond

3 years

Really helpful…… I think that the vast majority of surgeons are having conversations as regards BMI, smoking and HBA1C….. but I certainly have not been focusing on the significance of albumin levels…. Will be part of my conversation from now on….

Arthroplasty Today

@ArthroToday

3 years

Low albumin is the greatest increased risk of infection, readmission, complication, & mortality after #THA . #OrthoTwitter , are you checking? @womenAAHKS @AlexisGaskin32 @JennaBernstein7 @realDrHartzler @LindaSuleimanMD @BrianChalmersMD @ashtongoldmanmd

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Knee Surg in London

@kneedoclond

1 year

@generalorthomd That is a bizarre ratio of admin to care givers/providers. Seems that the hospital is set up to provide employment for local administrators, rather than medical care for local community, Lego Man…..

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Knee Surg in London

@kneedoclond

3 years

It’s getting to be that time of the year again….. Tweed suit Thursday. Great to be wearing a tie again and finding the pocket square to match….. #DetailsMatter #orthotwitter

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Knee Surg in London

@kneedoclond

1 year

Re-rupture of ACL recon, with re-injury to MCL and significant medial opening.... Sometimes a two stage is the ONLY option, at least in my hands..... #orthotwitter #ACLrevision

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Knee Surg in London

@kneedoclond

4 years

Another day in clinic and another ACL reconstruction placed where the native ligament doesn’t normally meet the femur... Patient previously informed that graft is intact and healthy....which is true, but not the whole story.....

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Knee Surg in London

@kneedoclond

3 years

When anatomy allows, double tunnel technique improves the footprint with lateral meniscal root avulsion repair…. Combined with ACL reconstruction (and modified Lemaire LET) in this case…. #savethemeniscus #aclreconstruction

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Knee Surg in London

@kneedoclond

1 year

@ellasmammy No incisions, no blood, no issues and SFW…!!!!!! Always post “warnings” when there are open wounds……. Wobbly knees are “normal” in my World…. 😬

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Knee Surg in London

@kneedoclond

2 years

@LenMacPT Yep…. We are all skeptical as to the 90% healed and if they are functional. How come when I look inside the knee at time of ACL reconstruction the ACL is lax, stuck into the PCL or not identifiable as a structure, if all these torn ACL’s are healing…..?

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Knee Surg in London

@kneedoclond

1 year

@generalorthomd @AbonemanL @KWatsonMD BHG….. must use that more often, and in a more general setting…. Nice

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Knee Surg in London

@kneedoclond

2 years

@jointdocShields @Seattsma12 @kerryjax71 @aracelia665 @shesingsforfree @Teknowledge420 @djschuett @CardiacPA1 @generalorthomd @TraumaSoapBoxes @PhilWalmsley4 @FixnBones @doctorgelber @Weisburgermd @rkh_md

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Knee Surg in London

@kneedoclond

2 years

All-inside versus inside-out meniscal repair: A systematic review and meta-analysis @traumaticum Lower complication rate wrt nerve injury, with all inside…No loss of outcome, using all inside vs in-out…

All-inside versus inside-out meniscal repair: A systematic review and meta-analysis - PubMed

All-inside meniscal repair is associated with reduced operative time and a lower odds of nerve injury complications compared to inside-out repair, without compromising meniscal healing or functional...

pubmed.ncbi.nlm.nih.gov

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Knee Surg in London

@kneedoclond

2 years

City of London on a sunny lunchtime ……….looking forwards to seeing Chicago tomorrow, ready for the American Academy @AAOS1 #AAOS2022 #orthotwitter #AlwaysLearning

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Knee Surg in London

@kneedoclond

1 year

Been informed that Rolfe Birch, peripheral nerve surgeon, passed away yesterday… One of the most talented teachers & lecturers I have ever met & an outstanding technical surgeon. Time with him was never wasted, at RNOH in the 90’s. #orthotwitter #Education #RolfeBirch

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Knee Surg in London

@kneedoclond

5 years

Challenging practice “just” being a knee surgeon... 2 root repairs + ramp in 4 ACL recon and a KD3M (3 ACL with lateral augment) since Tuesday, amongst others.. But, most testing was the long clinic consult with elite rugby player post bilat ACL & anxiety wrt reinjury & RTP

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Knee Surg in London

@kneedoclond

2 years

@generalorthomd @jointdocShields @CenterRotation @BoneDocMMD @drsebheaven @HoganMDCraig @tdd340 @aschwartz45 @EdinburghKnee @NuelleSportsMD Direct repair….semiT left on AM tibia, passed through small oblique 4.5 mm drill hole, junction distal and central 1/3 patella and down to drill hole AL tibia. FibreTape loop, via 2.5 mm tuberosity drill hole and same hole as ST graft. Works every time, 85% of the time…

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Knee Surg in London

@kneedoclond

2 years

This is not where one would aim to normally place the tibial footprint in a PCL reconstruction. Message ends. GiRFT. #orthotwitter

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Knee Surg in London

@kneedoclond

2 years

1/3 27 Male rugby player, with failed HS ACL recon, 5 years prior. Re-injury, but never achieved functional stability. Graft tear. Lateral root tear (missed) and medial meniscal tear. Very vertical femoral tunnel position.. #orthotwitter #ACLrevision #KneeInstability

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Knee Surg in London

@kneedoclond

2 years

@FixnBones But, only when chilly, obvs. Ordinary business suit, tie and cuff-links on warmer days…….

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Knee Surg in London

@kneedoclond

1 year

Great session from #orthotwitter legend ⁦ @EdinburghKnee ⁩ educating at #BASK2023 on complex per-prosthetic knee fractures… Go Chloe……

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Knee Surg in London

@kneedoclond

3 years

Preserving the posterolateral bundle when possible and reconstructingA-M bundle in isolation, improves outcome and proprioception post ACL recon, although it is rarely possible. #orthotwitter #sportsknee #aclreconstruction

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Knee Surg in London

@kneedoclond

1 year

Mrs MSK Radiologist just messaged me to say she wants to discuss knee MRI with chronic ACL, ramp, probable lateral root and chondral loss this evening… 😍🥰 She knows how to sell a scan. #MarryAboveYourself #ScansAtDinnerTime #orthotwitter

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Knee Surg in London

@kneedoclond

2 years

Here’s Celebrating a wonderful colleague’s 60th Birthday. Always a pleasure working with Sister Nikki on an “NHS Tuesday” #orthotwitter #WorkingTogether #HappyBirthdays . #StormzySoundtrackToday #NHS

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Knee Surg in London

@kneedoclond

1 month

Sometimes, even when the trout are not taking the fly, just being there can change the day. Another beautiful spot in Devon…… #FlyFishing #Great2BOutside #orthotwitter

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Knee Surg in London

@kneedoclond

4 years

Getting a patient to slowly march on the spot, while viewing from behind helps to pick up subtle dynamic alignment issues, as they go into single leg stance...mild varus sag on the right in this case. Video with patients permission.

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Knee Surg in London

@kneedoclond

3 years

Well, it looks as though central London has decided that working from home, or else extending the Christmas holiday break is the right way forwards. #WeAreLondon ⁦ @TfL ⁩ Northern Line can be a bit busier in the morning commute 😷

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Knee Surg in London

@kneedoclond

3 years

@metpoliceuk @MayorofLondon Was running a resuscitation bay at St Thomas’ Hospital. Not a day to forget….. Large numbers of lives permanently changed day to day, for those left behind, and those victims still with the physical and mental injuries……

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Knee Surg in London

@kneedoclond

3 years

CT scans prove invaluable when planning for revision ACL reconstruction...........

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Knee Surg in London

@kneedoclond

2 years

#orthotwitter @AAOS1 and Vegas meeting. Looking to book. Roll call 4 the event, please @jointdocShields @generalorthomd @RyanHessMD @rkh_md @PhilWalmsley4 @NaanDerthaal @Peds_Ortho @FKSMC_Getgood @txsportsdoc @sportsdrsean @CenterRotation @mymomthesurgeon @SSittonMD @drspoon8

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Knee Surg in London

@kneedoclond

5 months

Beers always part of a comedy outing…….

Knee Surg in London

@kneedoclond

5 months

Looking forwards to some stand up with Mrs MSK Radiologist this evening….. #LondonLife

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Knee Surg in London

@kneedoclond

21 days

Thanks Denver for hosting a fantastic few days…… Long flight home, but well worth the trip. Already have Nashville in the diary for 2025…… #AOSSM2024 #orthotwitter

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Knee Surg in London

@kneedoclond

3 years

Nice work…. Will be purchasing a copy……

Clayton Nuelle, MD, FAAOS

@NuelleSportsMD

3 years

This is a comprehensive book on all things cartilage. Happy to be part of it. #orthotwitter #cartilage @DrKrych @mayoclinicsport @MUOrthopaedic

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Knee Surg in London

@kneedoclond

2 years

Excellent educational event and catch up with colleagues, discussing complex knee cases. Huge thanks to James Robinson from Bristol on an amazing update on management of complex meniscal lesions #orthotwitter #SaveTheMeniscus

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Knee Surg in London

@kneedoclond

2 years

3/4. Plate removal. QT autograft revision ACL, with LET, and simultaneous medial meniscal allograft….. No 4k stacks in NHS theatres…😬 Anterior root tunnel for medMAT, ACL tibial tunnel, medial MAT out-in suture and QT graft

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Knee Surg in London

@kneedoclond

2 years

Flights sorted & registration for AAOS Chicago 👍🏻 Not been to an international meeting since 2019 & getting as excited as a (late) middle aged knee reconstruction surgeon can get, at the thought of exchanging ideas and techniques with colleagues….. #AAOS2022 #orthotwitter

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Knee Surg in London

@kneedoclond

2 years

3/3 Second stage with QT based revision ACL 5/12 post bone grafting. FibreTag femoral fixation. Lateral root tear repair & LET using modified Lemaire technique. 6 weeks post op and now allowed FWB and unrestricted ROM

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Knee Surg in London

@kneedoclond

2 years

I think Mrs MSK Radiologist MIGHT have found time to go boot shopping, while lecturing in Austin, Tx… #orthotwitter #Ladies &theirShoes Important to have reminders of times spent traveling….. and engaging in Continuing Professional Development

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Knee Surg in London

@kneedoclond

2 years

@generalorthomd @jointdocShields @BoneDocMMD @Dr_Stambough @NaanDerthaal @CenterRotation Good soft tissues at least… not the deep down stuff, obvs, but the superficial stuff that keeps the bugs out. Hinge for me, every day of the week and twice on a Friday…….

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Knee Surg in London

@kneedoclond

1 year

AOSSM 2023 begins…. #orthotwitter ⁦ @AOSSM_SportsMed ⁩ ⁦ @generalorthomd ⁩ ……🥳😉

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Knee Surg in London

@kneedoclond

1 month

Just about a week to go until the United flight to Denver for AOSSM 2024…. Getting VERY excited to visit a new US city (to me) and to catch up on Knee Sports Med and Knee Preservation updates and developments… #AOSSM2024 #Denver #OrthoTwitter @aossm1972

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Knee Surg in London

@kneedoclond

2 years

@rkh_md Splitting hairs, but why not in a back slab for the post reduction radiographs….???? Would have given my resident a bollocking/educational upgrade for not splinting the injury, for analgesia, if nothing else. Would defo have been reprimanded if I were the trainee Just Saying….

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Knee Surg in London

@kneedoclond

4 years

Hmmmmmm. Not entirely certain that the wife’s new radiology reporting from home station might not be a little too large for the desk... the 21” Mac seems somewhat dwarfed... 🙄

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