Publications by authors named "Andrew Metcalfe"

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the benefits and harms of injury prevention programmes on anterior cruciate ligament injuries.

View Article and Find Full Text PDF

Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive disease characterized by complex metabolic rewiring that enables growth in changing nutrient availability and oxygen conditions. Transcriptome-based prognostic PDAC tumor subtypes, known as 'basal-like' and 'classical' subtypes are associated with differences in metabolic gene expression including genes involved in glycolysis. Tumor subtype-specific metabolism phenotypes may provide new targets for treatment development in PDAC, but their functional relevance has not been fully elucidated.

View Article and Find Full Text PDF

Objectives: The Oxford knee score (OKS) and OKS Activity and Participation Questionnaire (OKS-APQ) are patient-reported outcome measures used to assess people undergoing knee replacement surgery. They have not explicitly been tested for unidimensionality (whether they measure one underlying trait such as 'knee health'). This study applied item response theory (IRT) to improve the validity of the instruments to optimize for ongoing use.

View Article and Find Full Text PDF
Article Synopsis
  • * The REPPORT trial is a multicenter study comparing personalized rehabilitation to surgery for managing this condition, targeting 276 participants across the UK and using random assignment to treatment groups.
  • * The trial will evaluate effectiveness based on participant-reported outcomes over 18 months and gather additional data on health impacts and resource use, with results set to be shared in peer-reviewed publications.
View Article and Find Full Text PDF

Background: Anterior cruciate ligament reconstruction (ACLR) is most commonly performed with hamstring tendon (HT) or bone-patellar tendon-bone (BTB) autografts, although the quadriceps tendon (QT) autograft has recently increased in popularity. This systematic review and meta-analysis review compares QT and HT autografts for primary ACLR with a sole focus on randomised controlled trials (RCTs).

Methods: A prospective protocol was registered on PROSPERO (CRD42023427339).

View Article and Find Full Text PDF

Aims: This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology.

Methods: Initial research questions were generated using an online survey sent to all 680 members of the British Association for Surgery of the Knee (BASK). Duplicates were removed and a longlist was generated from this scoping exercise by a panel of 13 experts from across the UK who provided oversight of the process.

View Article and Find Full Text PDF

Introduction: Pain and disability after meniscectomy can be a substantial lifelong problem. There are few treatment options, especially for young people. Non-surgical management (rehabilitation) is an option but increasingly surgeons are performing meniscal allograft transplants (MATs) for these individuals.

View Article and Find Full Text PDF

Aims: During total knee replacement (TKR), surgeons can choose whether or not to resurface the patella, with advantages and disadvantages of each approach. Recently, the National Institute for Health and Care Excellence (NICE) recommended always resurfacing the patella, rather than never doing so. NICE found insufficient evidence on selective resurfacing (surgeon's decision based on intraoperative findings and symptoms) to make recommendations.

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to understand individuals' perspectives on recovery after total knee replacement (TKR) and identify key recovery areas they deemed important.
  • Semi-structured interviews were conducted with 12 participants at various stages of their TKR journey, using thematic analysis to uncover common themes including pain, function, and fears related to surgery.
  • Findings emphasized the significance of pain management and mobility as central concerns for TKR patients, suggesting that these aspects should be considered in both clinical practice and future research designs.
View Article and Find Full Text PDF

Objective: To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures.

Methods: We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures.

View Article and Find Full Text PDF

Background: The Forgotten Joint Score (FJS), a commonly used patient-reported outcome measure, was developed without fully confirming assumptions such as unidimensionality (all items reflect 1 underlying factor), appropriate weighting of each item in scoring, absence of differential item functioning (in which different groups, e.g., men and women, respond differently), local dependence (pairs of items are measuring only 1 underlying factor), and monotonicity (persons with higher function have a higher score).

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to identify key unanswered questions about preventing, diagnosing, treating, and rehabilitating first-time soft-tissue knee injuries in children and adults.
  • Using the James Lind Alliance methodology, over 1,000 questions were gathered from patients and healthcare professionals in the UK, narrowing down the inquiries to 74 based on common concerns.
  • The final ranking revealed the top ten priorities for future research, with the top question addressing the urgency of treatment for optimal outcomes, which has been submitted to the National Institute for Health and Care Research.
View Article and Find Full Text PDF

Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in an attempt to improve outcomes. Robust studies are needed to find out if these innovations are really benefitting patients.

View Article and Find Full Text PDF

Background: The haphazard adoption of new surgical technologies into practice has the potential to cause patient harm and there are many misconceptions in the decision-making behind the adoption of new innovations. The aim of this study was to synthesize factors affecting a surgeon's decision to adopt a novel surgical innovation into clinical practice.

Methods: A systematic literature search was performed to obtain all studies where surgeon views on the adoption of a novel surgical innovation into clinical practice have been collected.

View Article and Find Full Text PDF
Article Synopsis
  • Understanding how patients view recovery after total knee replacement (TKR) is crucial for clinicians to address concerns and manage expectations effectively.
  • The study reviews 23 research papers that identify 18 recovery themes, highlighting pain, daily activities, and mobility as the most crucial aspects for patients post-surgery.
  • Clinicians should consider these recovery themes during the pre-operative consultations, and future research is needed to assess the relative importance of these recovery attributes.
View Article and Find Full Text PDF

Background Virtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system.

View Article and Find Full Text PDF
Article Synopsis
  • The text discusses the growing use of robotic-assisted hip replacement surgeries, aimed at enhancing surgical precision and potentially improving patient outcomes despite higher costs compared to traditional methods.
  • A randomized controlled trial (RACER-Hip) will be conducted across multiple UK sites, involving 378 participants to compare outcomes between robotic-assisted and conventional total hip replacement surgeries.
  • The study aims to evaluate various factors, including pain, joint awareness, and overall satisfaction, with a thorough ethical review process already in place for participant consent.
View Article and Find Full Text PDF

Background: Injuries are a major cause of disability globally and injury incidence is rapidly increasing, largely due to road traffic injuries in low-income and middle-income countries. Current estimates of the scale and consequences of disability from injury are largely based on modelling studies, with a scarcity of empirical evidence from severe injuries in low-income countries. We aimed to better understand the outcomes for individuals with open tibia fractures in Malawi.

View Article and Find Full Text PDF

The prevalence and strength of serological responses mounted toward SARS-CoV-2 proteins other than nucleocapsid (N) and spike (S), which may be of use as additional serological markers, remains underexplored. Using high-content microscopy to assess antibody responses against full-length StrepTagged SARS-CoV-2 proteins, we found that 85% (166/196) of unvaccinated individuals with RT-PCR confirmed SARS-CoV-2 infections and 74% (31/42) of individuals infected after being vaccinated developed detectable IgG against the structural protein M, which is higher than previous estimates. Compared with N antibodies, M IgG displayed a shallower time-dependent decay and greater specificity.

View Article and Find Full Text PDF

Introduction: Robotic-assisted knee replacement systems have been introduced to healthcare services worldwide in an effort to improve clinical outcomes for people, although high-quality evidence that they are clinically, or cost-effective remains sparse. Robotic-arm systems may improve surgical accuracy and could contribute to reduced pain, improved function and lower overall cost of total knee replacement (TKR) surgery. However, TKR with conventional instruments may be just as effective and may be quicker and cheaper.

View Article and Find Full Text PDF

Purpose: There is considerable debate regarding the optimal method of fixation for lateral meniscus allograft transplantation (MAT), with bone bridge techniques technically harder but allowing maintenance of root attachments, while soft tissue techniques are potentially more challenging for healing. The aim of this study was to compare the clinical results of the bone bridge and soft tissue techniques for lateral MAT in terms of failure, re-operation rate, complications and patient reported outcomes.

Methods: Retrospective analysis of prospectively collected data for patients undergoing primary lateral MAT with a minimum of 12-month follow-up.

View Article and Find Full Text PDF

Background: Patellar (knee cap) dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. It affects up to 42/100,000 people, and is most prevalent in those aged 20 to 30 years old. It is uncertain whether surgical or non-surgical treatment is the best approach.

View Article and Find Full Text PDF

Background: Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter.

Purpose: To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure.

View Article and Find Full Text PDF

A PHP Error was encountered

Severity: Warning

Message: fopen(/var/lib/php/sessions/ci_sessiondfkmj55k3c19h6ouluvvm75jk2bkucuk): Failed to open stream: No space left on device

Filename: drivers/Session_files_driver.php

Line Number: 177

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: session_start(): Failed to read session data: user (path: /var/lib/php/sessions)

Filename: Session/Session.php

Line Number: 137

Backtrace:

File: /var/www/html/index.php
Line: 316
Function: require_once