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Neil P Thomas

Publications and source records attributed to Neil P Thomas.

6 recordsLinked to original sources
PubMed2006

Early MRI diagnosis and non-surgical management of spontaneous osteonecrosis of the knee.

Spontaneous osteonecrosis of the knee (SONK) is generally associated with a poor prognosis but the outcome depends on the clinical and radiological stage at which the patients present. The earliest stage of this condition does not necessarily progress in every patient, but discriminatory radiological information is lacking in order to differentiate these patients so that unnecessary surgical intervention can be avoided. We describe 20 sequential cases of early SONK diagnosed by magnetic resonance imaging (MRI) in which non-operative management led to the spontaneous resolution of symptoms and MRI changes. Our data was compared to published series in order to derive more accurate prognostic criteria that may then be used to determine appropriate management. Average age of patients was 52 years (42-64). All patients' symptoms resolved with conservative treatment at an average of 4.8 (3-8) months after symptoms began. All MRIs returned to normal. MRI prognostic criteria that appear to indicate a benign course are the absence of focal epiphyseal contour depression and the absence of lines of low signal intensity deep in the condyles. The presence of high signal T2 rim and a length >14 mm and depth >4 mm of the low signal T2 lesion did not necessarily indicate a bad prognosis. Early SONK in this group of patients resolves without surgical intervention. The group is typically middle aged, present with acute focal pain in the knee, have no secondary cause of osteonecrosis, have minimal or no changes on plain radiographs, and have focal changes on MRI. Recognition of this group using MRI identifies the earliest changes in SONK and gives prognostic information that avoids inappropriate surgical intervention.

Acetaminophen↗
PubMed2005

Revision anterior cruciate ligament reconstruction using a 2-stage technique with bone grafting of the tibial tunnel.

BACKGROUND: Revision anterior cruciate ligament surgery is often considered a salvage procedure with limited goals. However, this limitation need not be the case. Similar to primary reconstruction, the goal should be to choose an appropriate graft and place it in an anatomical position in a good quality bone. The issue of good quality bone seems to have been ignored. HYPOTHESIS: A 2-stage anterior cruciate ligament revision reconstruction with bone grafting of the tibial tunnel and the use of a different femoral tunnel will produce measured knee laxity and International Knee Documentation Committee scores similar to a primary anterior cruciate ligament reconstruction. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: This prospective study involved 49 consecutive 2-stage anterior cruciate ligament revisions (group R) performed by a single surgeon from 1993 to 2000. Two-stage revision surgery was performed if the tibial tunnel from a previous reconstruction surgery would overlap (either partially or fully) the correctly placed revision tunnel. The first stage consisted of removal of the old graft and interfering metalwork, together with bone grafting of the tibial tunnel. After ensuring adequate bone graft incorporation using computed tomography scan, the second stage revision was undertaken. This stage comprised harvesting the autograft, its anatomical placement, and its adequate fixation. The results were compared with the results of a matched group of patients with primary anterior cruciate ligament reconstruction (group P). RESULTS: In group R, as meniscal and chondral lesions were more common, the International Knee Documentation Committee scores were lower than those of group P (61.2 for group R and 72.8 for group P; P = .006). Objective laxity measurement was similar in both groups (1.36 mm for group R and 1.2 mm for group P; P = .25). CONCLUSION: This study establishes that the laxity measurements achieved with a 2-stage revision anterior cruciate ligament reconstruction can be similar to those achieved after primary anterior cruciate ligament reconstruction, although the International Knee Documentation Committee rating is lower.

Adult↗
PubMed2004

The accuracy of magnetic resonance imaging in diagnosing chronic posterior cruciate ligament injury.

Magnetic resonance imaging (MRI) is widely believed to be highly accurate in diagnosing injuries of the posterior cruciate ligament (PCL). The aim of this study was to determine the accuracy of MRI in diagnosing chronic PCL injury. MRI was performed on 10 knees with a clinical and arthroscopic diagnosis of a PCL injury sustained at least 6 months previously. Seven experienced musculoskeletal radiologists subsequently reviewed the scans. Their accuracy in diagnosing a PCL injury was 57% (40-80%). Thus, although MRI may be reliable in diagnosing acute PCL injury, MRI is not so reliable in evaluating chronic injuries. We postulate that, in the case of a chronic PCL injury, healing in continuity may occur, producing an intact but lax ligament. As demonstrated by our study, MRI may then be less accurate. This should be borne in mind when assessing the MRI scans of a suspected chronic PCL injury.

Adult↗
PubMed2004

Regional orthopaedic courses--rationale and practice.

BACKGROUND: The intensity and length of higher surgical training has changed, and with this the need for a more formalised training programme has been recognised. With limited budgets for training and the high cost of national training days, it was proposed that within the Wessex Deanery regional courses should be run to complement the existing weekly training session. METHODS: In 1998, a questionnaire was sent to all the orthopaedic consultants and specialist registrars within the region to identify the training requirements of the specialist registrars and the availability of consultants to organise and teach during these training courses. RESULTS: A regionally published report based on the questionnaire's findings identified these training requirements as indicated by both the specialist registrars and the consultants. This information has been used to organise eight 1-day training courses using the expertise of consultants within the region with more planned in the near future. CONCLUSIONS: Four years following this report, we identified the training requirements within the Wessex region and have successfully run regional courses to meet this requirement.

Education, Medical, Graduate↗