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| HONORARY PROFESSOR McNICHOLAS |
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| CLINICAL EXPERIENCE |
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| PUBLICATIONS |
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| RESEARCH |
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| TEACHING |
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| TEACHING PRESENTATIONS |
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| ADMINISTRATION |
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| AUDIT |
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| POSTERS |
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Research I have been elected as co-ordinator of a prospective multicentre study based on both the Warrington knee Injury Database of the results of complex ligament reconstruction and an audit of complications of anterior cruciate ligament (ACL) reconstruction by the 20.20 Club (a UK wide specialist knee surgeons group). Whilst working as my Fellow, Yioannis Pengas presented The development of the “Warrington Knee Injury Database” to the following knee surgery units who have agreed to participate: Glasgow Royal Infirmary & Western General, Glasgow (16th May 2005); Northern General Hospital, Sheffield (27th May 2005); Ipswich Hospital, Ipswich (10th June 2005). I have instigated a number of studies of knee arthroplasty using data from the University of Dundee Arthroplasty database. I have gained ethical approval and secured cost neutral funding for a prospective randomised controlled trial of the Hi-Flex knee versus a conventional prosthesis Nexgen LPS investigating differences in range of motion and early a late outcome measures. Independent peer review of the proposal was obtained prior to completion of the COREC ethics form. Proposed centres involved are Warrington Hospital, South Warwickshire Hospital, Ipswich Hospital and University of Dundee. The various centres are applying for Local Ethical Committee approval now. The study commenced in April 2006. I have been a supervisor for two University of Cardiff MSc theses entitled Posterolateral Corner Reconstruction In The Knee and Double Bundle Posterior Cruciate Ligament Reconstruction; a University of Salford, Biomechanics of the lower limb for health care professionals thesis entitled An investigation into the effects of physiotherapy and foot orthoses on the kinetics and the kinematics of the knee in subjects with anterior knee pain; a University of Bath Sports Medicine MSc and a University of Dundee MD Thesis project: Menisectomy in adolescence: a 40 year follow-up. The Swedish Ligament Reconstruction Audit Database is based in the Capio Arthroclinic (Karolinska Institute) which is now internet based with multi-centre international collaborations currently used for data collection in Sweden, Norway, Denmark and Italy. My Fellow, Yioannis Pengas was invited to present The development of the “Warrington Knee Injury Database” to their knee surgery unit on the 27th June 2005. We are working to incorporate elements of the Warrington knee Injury Database within their database, to enhance their dataset and encourage further international collaboration. As the Edinburgh knee fellow, I reviewed the unit’s experience of posterior cruciate ligament reconstruction and ran collaborative studies in clinical objective measurement of anteroposterior laxity of the knee with Prof. Jakob’s unit in Fribourg. I set up the Edinburgh part of a three-centre validation study of the stress radiographic assessment of posterior cruciate ligament damage using the PCL-Press device designed by Dr Assal of Geneva, Switzerland. He was awarded the Orthopaedics Today Technological Advancement Award for the PCL-Press at European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) in London, September 2000. The Rolimeter is a knee laxity measurement device and I have been involved in a number of validation studies of differing aspects of its use with results published as outlined below. My MD thesis "Meniscectomy and osteoarthritis" was based on work carried out during the year I spent as the Tayside Health British Orthopaedic Associationrd Research Fellow in Surgery, and Honorary Research Fellow of the University of Dundee. I studied aspects of the aetiology, pathophysiology, conservative and surgical treatments of osteoarthrosis in the knee. I carried out the thirty-year follow-up of Honorary Professor Smillie’s patients who underwent total meniscectomy before the age of 18. A Swedish research fellow had carried out the 17-year review; the thirty-year review was carried out in collaboration with the University of Lund, where he was then based. Synovial fluid, serum, and urine samples collected from these patients were investigated for various markers of osteoarthritis. I measured nitric oxide activity in the samples at the Glaxo-Wellcome Research Laboratories, in Beckenham, Kent. The results of these investigations have been related to radiological findings in my thesis. The cohort has also been investigated biomechanically, with radiological and three-dimensional gait analysis studies relating the external knee adduction moment to osteoarthritic changes and the type of meniscus excised. The cohort has now reached the 40 year review stage, ethical committee approval has been granted. I arranged funding for the clinical and radiological review and synovial fluid collection from both knees, by one of my former Knee Fellows, who has completed the reviews and sample collections. The collaboration with Lund University in Sweden continues and will enable further investigation of various cartilage metabolism markers. As a Clinical Trial Investigator for Inveresk Clinical Research Ltd., I ran a Clinic at Perth Royal Infirmary for patients with osteoarthritic knees. This was part of a multicentre double-blind placebo controlled trial of the effectiveness and tolerance of intra-articular injections of sodium hyaluronate. I studied Tayside’s experience with the Ilizarov external fixation system, and investigated the biomechanical effects of external fixation after upper tibial osteotomy for osteoarthritis. I have a long-standing interest in sports medicine. I was the sports injuries theme co-ordinator for the World Golf and Science III Congress held at St Andrews University in June 1998, and a member of the Scientific Committee of the World Golf and Science Trust. I am a member of the British Association of Sport and Exercise Medicine and an elected Fellow of the Faculty of Sports and Exercise Medicine of the Royal College of Surgeons in Ireland. During my Lectureship in Dundee I assisted other trainees in their clinical research; the first such paper was presented at the Scottish Orthopaedic Meeting in Stirling, June 1997, winning the Michael Turner Memorial Prize. The Smillie meniscectomy cohort has now passed the 40 year review stage, ethical committee approval was granted for their review. I arranged funding for the clinical and radiological review and synovial fluid collection from both knees. The collaboration with Lund University in Sweden continues and will further investigation of various cartilage metabolism markers is underway. The collaboration now involves a group in London, and the first work from the study has been presented at the Pott’s Surgical Meeting the in October this year. I am supervising Yiannis Pengas writing his University of Dundee MD Thesis project: Menisectomy in adolescence: a 40 year follow-up. I am supervising a Research Fellowship by Mr Kevin Rourke together in collaboration with Professor Don MacLaren, of John Moores University, Liverpoool and Mr Andrew Taylor and Mrs Jo Banks of Broadgreen Hospital, Liverpool. To date approximately 50 patients have been randomized in a prospective trial studying the effect of protein supplementation upon the early outcome of reconstruction of the anterior cruciate ligament. Mr Rourke is presenting this work as a University of Cambridge MD Thesis. I am supervising a University of Dundee MD Thesis project: Menisectomy in adolescence: a 40 year follow-up. I am supervising a Research Fellowship by Mr Kevin Rourke together in collaboration with Professor Don MacLaren, of John Moores University, Liverpoool and Mr Andrew Taylor and Mrs Jo Banks of Broadgreen Hospital, Liverpool. To date approximately 50 patients have been randomized in a prospective trial studying the effect of protein supplementation upon the early outcome of reconstruction of the anterior cruciate ligament. Mr Rourke is presenting this work as a University of Cambridge MD Thesis. I have been asked to supervise Dr S Hammouche working on his PhD Thesis at the Dept of Mechanical Engineering in Leeds. I studied Tayside’s experience with the Ilizarov external fixation system, and investigated the biomechanical effects of external fixation after upper tibial osteotomy for osteoarthritis. Currently, my own experience with Ilizarov treatment of complex and periarticular tibial fractures has been reviewed and a paper outlining the outcome of these is being peer reviewed was presented at ASIT in Birmingham and at SICOT in Hong Kong 2008. I was approached by Everton Football Club in the 2007-8 pre-season to look after their injured players and worked with them for two seasons. I now treat PFA players referred from a number of clubs in the North of England. Academic Co-supervisor for Mr Kevin Rourke for his University of Cambridge MD thesis entitled “Peri operative protein supplementation in anterior cruciate ligament reconstruction.” I would supervise the surgical aspects of the thesis working alongside Prof D MacLaren who would supervise the Sports Nutrition aspects of the work. The 20:20 club is a special interest group of 25 fellowship trained specialist knee surgeons, working in different centres in Scotland and England. I will host the meeting next year, inviting Prof Roli Jakob a internationally reknowned expert in the use of ostetomies about the knee to address ligament damage, from Switzerland and a number of UK surgeons to present their research in soft tissue knee surgery. I aim to present the results of a multicentre study of which I am the research lead of outcomes of acl recon in children under 16, in which 15 fellowship trained specialist knee surgeon working in different centres in Scotland and England will review all their cases with 2-10 year follow-up clinically and radiographically to ascertain the incidence of growth plate arrest and other complications and functional outcomes in a wide range of hospital settings. Ongoing Projects Outcome in patients failing to attend follow-up clinics after ACL recon. (IRAS form finished) Outcme in negative knee arthroscopy. (on-going) www.mcnicholaskneeclinic.co.uk
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