Knee Arthroscopic Surgery, Articular Cartilage Repair, Stem Cell Therapies, ACL Reconstruction, Joint Replacement
Home Knee Imaging Knee Problems Sports Knee Injuries Rehabilitation Pain Management CKC News

Chester Knee Clinic News 2009

Skiing & Snowboarding Injuries: 2009 Update

Chill Factor-e, Manchester, 22 October 2009. Programme

We held our annual Skiing & Snowboaring Injury Seminar at Chill Factor-e in Manchester, which was a superb venue for this seminar. It was attended by 30 GPs and Physiotherapists. The seminar focused on injury prevention, early diagnosis and treatment, in preparation for the upcoming ski season. Following each talk, which was given by an experienced specialist, there was plenty of time to discuss the subject of the talk and ask questions. During the evening, we also demonstrated ski and snowboarding equipment, with emphasis on how to choose and fit individual components. Invited Faculty:

  • Vladimir Bobic, Consultant Orthopaedic Knee Surgeon (, Chester
  • Nick Geary, Consultant Orthopaedic Foot and Ankle Surgeon, Chester
  • Mike Langran, GP, Aviemore Medical Practice; Board Member, International Society for Skiing Safety (,
  • David Ritchie, Consultant Musculoskeletal Radiologist, Glasgow
  • Andrew St Clair Logan, Consultant in Anaesthesia and Pain Medicine, Chester
  • Rob Statham, Snow + Rock Team, (, Didsbury

We would like to thank those who attended the seminar, as well as our speakers for sharing their experience with us. We are again particularly grateful to our guest speakers from Scotland, Dr Mike Langran from Aviemore and Dr David Ritchie from Glasgow, who travelled such a long way to Manchester and back.

We are planning our next seminar on Prevention and Treatment of Skiing and Snowboarding Injuries for Saturday, 23 October 2010. If you would like to book a place please contact us on 01244 881 931 or, or contact Ailsa Rainey on 01244 684 343 or The number of places will be probably limited to 50. We will post more information on this seminar early next year. We look forward to seeing you there.

Cycling & Running Seminar: 2009 Update

Chester, 7 May 2009. Programme

Following the success of last year’s educational events, we continued our annual Educational Seminars in partnership with the Grosvenor Hospital Chester, with a seminar on Cycling and Running Injuries for local GPs and Physiotherapists on 7th May.  The seminar once again presented an update on technology and treatment options, focusing on cycling and running lower limb injuries. Our six experienced speakers discussed advances in knee imaging and  the prevention, diagnosis and treatment of cycling and running injuries, as well as pain management and rehabilitation.

Unfortunately, the team from Chester Specialized Concept Store were unable to attend and advise on proper bicycle fit, but Michael Callaghan joined us from the University of Manchester to fill us in on cycle training, injury prevention and rehabilitation. The speakers on the evening were:

  • Ronan Banim, Consultant Orthopaedic Lower Limb Surgeon, Chester
  • Vladimir Bobic, Consultant Orthopaedic Knee Surgeon, Chester
  • Michael Callaghan, Clinical Specialist & Research Associate, University of Manchester
  • Nicholas Geary, Consultant Orthopaedic Foot and Ankle Surgeon, Chester
  • David Ritchie, Consultant Musculoskeletal Radiologist, Glasgow
  • Andrew St Clair Logan, Consultant in Anaesthesia and Pain Management, Chester

The programme was comprehensive but we managed to fit everything in, including some discussion time after each presentation. Attendance surpassed last spring’s seminar: the places were overbooked, but we managed to accommodate over 40 guests in the Jubilee room. An engaging and enlightening evening was had by all.

We would like to thank those who attended the seminar, as well as our speakers for sharing their experience with us, and for their enjoyable and informative presentations.

CKC LogoCKC Logo

Chester, March 2009

Last year we started designing our own logo, based on the fact that we do knees only. We are pleased to say that this work has been completed and that the new logo has been approved by the directors of the Chester Knee Clinic. The logo was designed by Marta Bobic, Davis Silis and Ivana Bobic.


Latest Orthopaedic News

Updated on 3 December 2009

Pain Often First Sign of Knee Osteoarthritis

Medscape Orthopaedics, from Reuters Health Information, 20 November, 2009

A 12-year study in middle-aged adults suggests that knee pain is frequently the first sign of knee osteoarthritis. Knee pain is common, and may well be an early feature of knee osteoarthritis, but studies to confirm the relationship are sparse. The study, reported in the Annals of the Rheumatic Diseases for December 2009, featured 143 adults with knee pain lasting for longer than 3 months. Weight-bearing postero-anterior radiographs of both tibiofemoral joints had been taken at baseline and again at 12 years, while radiographs to assess patellofemoral disease were taken at 5 and 12 years. The tibiofemoral radiographs were rated using the Kellgren/Lawrence scale with a score of 1 or higher indicating osteoarthritis. With the patellofemoral radiographs, a joint space width of <5 mm was considered positive for osteoarthritis. At baseline, 76 subjects (53%) had no tibiofemoral osteoarthritis on x-ray, 30 had unilateral osteoarthritis, and 37 had bilateral osteoarthritis.

During follow-up, 65 of the 76 subjects without tibiofemoral osteoarthritis at baseline developed the condition on x-ray. This included 44 of 49 subjects (90%) with clinical osteoarthritis at baseline and 21 of 27 subjects (78%) without clinical osteoarthritis. Disease progression was seen in 65 of the 67 (97%) patients with tibiofemoral osteoarthritis at baseline. Eighty-four subjects had no patellofemoral osteoarthritis at 5 years, but 26 (31%) had developed it by 12 years.

"A majority of middle-aged patients with chronic idiopathic knee pain in this study developed knee osteoarthritis over 12 years," the authors state. On this basis, they conclude, "knee pain is often the first sign of knee osteoarthritis."

Ann Rheum Dis 2009;68:1890-1893.

Association between radiographic features of knee osteoarthritis and pain

BMJ, 29 August 2009

In terms of tackling the conundrum of discordance between structure and symptoms, this study has confirmed that a strong structure-symptom association definitely exists in osteoarthritis of the knee. Our findings add credence to ongoing efforts to useMRI studies to better understand underlying pathological structures that may be contributing to the pain of osteoarthritis. Thus, radiographic severity, as determined by Kellgren and Lawrence grades and individual radiographic features, particularly joint space narrowing, is a strong risk factor for the presence, consistency, and severity of knee pain and accurately reflect the presence of painful pathology. Read more:

Tuhina Neogi et al.: Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ 2009;339:b2844.

Delayed ACL repair in young patients linked to other injuries

AAOS Headline News Now, 13 July 2009

Delaying repair of the anterior cruciate ligament (ACL) in younger athletes can increase the risk of other damage, including meniscus tears, chondral injuries, and patellotrochlear injuries, according to data presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM). The research team analyzed the records of 69 patients younger than age 14 who had undergone ACL reconstruction between 1991 and 2005. All patients who elected to delay treatment were instructed to wear a custom ACL brace, and all patients who underwent the surgery received a soft tissue graft with anatomically placed tunnels and fixation devices that did not cross the growth plate. Researchers found that a delay in treatment of more than 12 weeks was associated with a 4-fold increase in irreparable medial meniscus tears, an 11-fold increase in lateral compartment chondral injuries, and a 3-fold increase in patellotrochlear injuries. Additionally, those who delayed treatment had significantly more issues with instability in the knee.

Long-term follow-up highlights the durability and efficacy of ACI surgery

Source: Gina Brockenbrough, 1st on the web, ORTHO SuperSite, June 3, 2009.

Autologous chondrocyte implantation (ACI) can provide high rates of patient satisfaction and maintain good outcomes at long-term follow-up, according to a Swedish study presented at the 8th World Congress of the International Cartilage Repair Society in Miami, 23 - 26 May 2009.

The investigators assessed 224 patients who underwent ACI performed with the periosteum using the Lysholm, Tegner-Wallgren and Brittberg-Peterson scores preoperatively and at 3 years and 10 to 20 years postoperatively. The study group had an average follow-up of 13.8 years. The investigators found a statistically significant improvement in all of the outcome measures at 3 years compared to baseline results. A comparison of mid-term to long-term results showed that the Lysholm score changed from 73.64 to 69.49. The Tegner-Wallgren score shifted from 8.4 at 3-year follow-up to 8.2 at long-term follow-up, and the Brittberg-Peterson score moved from 31.29 to 40.87. At long-term follow-up, 73% of the patients reported that they felt better or the same compared to the 3-year follow-up. In addition, 92% of the patients reported that they would have the procedure again. Read more ...

  • Vasiliadis HS, Concaro S, Brittberg M, et al. Autologous chondrocyte implantation: 10-20 years follow-up. Paper #15.3.1. Presented at the 8th World Congress of the ICRS. May 23-26, 2009, Miami.

Off-label use of a collagen membrane for ACI in United States shows decreased hypertrophy

Source: Gina Brockenbrough, 1st on the web, ORTHO SuperSite, June 3, 2009.

Andreas Gomoll and his colleagues have shown that performing autologous chondrocyte implantation (ACI) with a collagen membrane approved for dental procedures leads to statistically significant lower reoperation rates for hypertrophy-related issues than ACI with a periosteum. To avoid periosteal hypertrophy, European surgeons have, for some time, switched to using collagen membranes in ACI*. However, no U.S. FDA-approved collagen membrane exists for this indication. "Our research confirmed prior reports from Europe, which has an official collagen membrane for that indication," Andreas H. Gomoll, MD, said during his presentation at the 8th World Congress of the International Cartilage Repair Society in Miami.

Gomoll and his colleagues compared the results of their last periosteal ACI procedures performed in 100 patients with the outcomes of 54 patients who underwent ACI using a Type I/III bilayer porcine collagen membrane (BioGide, Geistlich Pharma*) and had a minimum 1-year follow-up. The investigators used reoperation within the first year for cover-related issues as their primary endpoint, and failure within the first year as a secondary endpoint. They found that the use of a collagen membrane dramatically lowers the reoperation rate from 52% to 6%, and there was no difference in the failure rate in the first year (one failure in each group).

  • Gomoll A, Probst C, Bryant T, et al. Decreased surgical re-intervention rate for hypertrophy after ACI with use of the BioGide collagen membrane. Paper #15.3.3. Presented at the 8th World Congress of the ICRS. May 23-26, 2009, Miami.
  • * This product is manufactured and marketed in Europe by Geistlich Pharma AG as Chondro-Gide. The Chondro-Gide® is a CE-marked bilayer collagen matrix which has been especially designed for articular cartilage repair methods. Chester Knee Clinic has been using this product for ACI surgery since 2004.

Exercise a benefit in regaining and keeping knee function

AAOS Headline News Now, 2 February 2009.

Two studies published in the 15 February issue of the journal Arthritis Care & Research highlight potential benefits of exercise in recovery from total knee arthroplasty (TKA) and in the prevention of osteoarthritis. In the first study, researchers conducted a randomized controlled trial of 200 patients undergoing primary, unilateral TKA for knee osteoarthritis and 41 patients eligible for enrollment who served as controls. Surgeries were performed between July 2000 and November 2005 in a single clinic. Patients in the experimental group received 6 weeks of outpatient physical therapy 2 or 3 times per week through 1 of 2 intervention protocols: volitional strength training, or volitional strength training with neuromuscular electrical stimulation (NMES). At 3 and 12 months, strength, activation, and function were similar between patients in the exercise and exercise-NMES cohorts, while patients in the control group were comparatively weaker and exhibited worse function at 12 months. Read the abstract ...

The authors of the second study used longitudinal data from 1,678 men and women, age 55-85 years, enrolled in a Dutch study on aging. Over a 12-year period, the patients were assessed for knee osteoarthritis (OA) and their physical activity was evaluated via a questionnaire. Overall, 463 respondents (28 percent) developed clinical knee OA. A high mechanical strain score and a low muscle strength score were associated with an increased risk of knee OA after adjustment for age, sex, region of living, education, lifetime physical work demands, lifetime general physical activity, body mass index, current total physical activity level, and depression. No association was observed in the intensity and turning actions components, and results were similar for men and women, and for obese and non-obese respondents. Read the abstract ...

Greater Quadriceps Strength May Benefit Those With Knee Osteoarthritis

AAOS Headline News Now, 14 January 2009.

A study published in the January issue of the journal Arthritis & Rheumatism finds that greater quadriceps strength may protect against cartilage loss at the lateral compartment of the patellofemoral joint, and may result in less knee pain and better physical function. The authors studied 265 patients (154 men and 111 women, mean age 67 years old) who were participating in a prospective, 30-month natural history study of knee osteoarthritis (OA). The researchers measured quadriceps strength at baseline, isokinetically, during concentric knee extension. They used magnetic resonance imaging to measure cartilage loss at the tibiofemoral and patellofemoral joints at baseline, 15, and 30 months. Knee pain and physical function were also measured at baseline, 15 months, and 30 months follow-up. No association was found between quadriceps strength and cartilage loss at the tibiofemoral joint. In malaligned knees, the results were similar. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint. Patients with greater quadriceps strength had less knee pain and better physical function over followup (P < 0.001). Read more ...


Latest Articles

updated on 29 December 2009

Does smoking influence outcome after autologous chondrocyte implantation (ACI)?

JBJS British Volume, December 2009.

Smoking is known to have an adverse effect on wound healing and musculoskeletal conditions. This case-controlled study looked at whether smoking has a deleterious effect in the outcome of autologous chondrocyte implantation for the treatment of full thickness chondral defects of the knee.

The mean Modified Cincinatti Knee score was statistically significantly lower in smokers (n = 48) than in non-smokers (n = 66) both before and after surgery (p < 0.05). Smokers experienced significantly less improvement in the knee score two years after surgery (p < 0.05). Graft failures were only seen in smokers (p = 0.016). There was a strong negative correlation between the number of cigarettes smoked and the outcome following surgery (Pearson’s correlation coefficient –0.65, p = 0.004).

These results suggest that patients who smoke have worse pre-operative function and obtain less benefit from this procedure than non-smokers. The results of ACI in ex-smokers were intermediate between those of smokers and non-smokers. The counselling of patients undergoing autologous chondrocyte implantation should include smoking, not only as a general cardiopulmonary risk but also because poorer results can be expected in smokers following this procedure.

Timing of Anterior Cruciate Ligament Reconstructive Surgery and Risk of Cartilage Lesions and Meniscal Tears: A Cohort Study Based on the Norwegian National Knee Ligament Registry

AJSM PreView, 26 February 2009

The authors studied the association between timing of anterior cruciate ligament reconstruction and the risk of having meniscal tears and cartilage lesions. All patients registered in the Norwegian National Knee Ligament Registry who had undergone primary anterior cruciate ligament reconstruction from 2004 and throughout 2006 were reviewed. Of a total of 3475 patients, there were 909 patients (26%) with cartilage lesions, 1638 patients (47%) with meniscal tears, and 527 patients (15%) with both cartilage and meniscal lesions. The odds of a cartilage lesion in the adult knee (>16 years) increased by 1.006 (95% confidence interval, 1.003-1.010) for each month that elapsed from injury to surgery.The cartilage in young adults (17-40 years) deteriorated further with an increase in odds of 1.03 (95% confidence interval, 1.02-1.05) related to the aging in years of the patient. The odds for meniscal tears in young adults increased by 1.004 (95% confidence interval, 1.002-1.006) for each month that elapsed since injury. The presence of 1 degenerative lesion increased the odds of having the other degenerative lesion by between 1.6 and 2.0 in all patient groups.

Conclusion: The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.

The Efficacy of Intra-Articular Hyaluronan Injection After the Microfracture Technique for the Treatment of Articular Cartilage Lesions

AJSM PreView, 9 February 2009

Although the exact mechanism of action has yet to be elucidated, recent animal studies have demonstrated chondroprotective and anti-inflammatory properties of hyaluronic acid viscosupplementation. The authors of this study examined the hypothesis that intra-articular hyaluronic acid after microfracture improves the quality of the repair leading to a more hyaline-like repair tissue with better defect fill and adjacent area integration. Conclusion: Supplementing the microfracture technique with 3 weekly injections of intra-articular hyaluronic acid had a positive effect on the repair tissue that formed within the chondral defect at the early follow-up time point. This improvement was not found for the 3-injection group at 6 months or for the 5-injection group at either time point. Additionally, hyaluronic acid supplementation had a possible chondroprotective and anti-inflammatory effect, limiting the development of degenerative changes within the knee joint. The adjunctive use of hyaluronic acid appears to hold promise in the treatment of chondral injuries and warrants further investigation.

Hyaluronic Acid Viscosupplementation and Osteoarthritis

AJSM PreView, January 23, 2009.

Intra-articular HA injection is gaining popularity as part of the nonoperative management of patients with osteoarthritis (OA). This article reviews the use of intra-articular hyaluronic acid viscosupplementation in the management of knee osteoarthritis and presents the potential for expanding its indications for other joints and alternative patient subpopulations. The anti-inflammatory, anabolic, and chondroprotective actions of HA have been shown in recent clinical studies to reduce pain and improve function. With evidence mounting in support of the efficacy of this treatment modality for patients with OA, its potential use in additional patient populations and other pathologies affecting the knee is being investigated. Although continued study is needed, intra-articular HA injection is proving to be a safe, effective, and evolving tool for clinicians treating patients with symptomatic OA.

  • Eric J Strauss, et al.: Hyaluronic Acid Viscosupplementation and Osteoarthritis. Current Uses and Future Directions. The American Journal of Sports Medicine PreView, 23 January 2009.

CKC Conference News

We are participating in the following international conferences:

  • European Autologous Chondrocyte Implantation (ACI) Meeting. Prague, Czech Republic, 6 & 7 February 2009. Invited speaker: Vladimir Bobic,
  • ISAKOS 7th Biennial Congress. Osaka, Japan, 5 - 9 April 2009. Invited speaker: Vladimir Bobic
  • 8th World Congress of the International Cartilage Repair Society (ICRS) . Miami, Florida, USA, 23 - 26 May 2009. Invited session moderator: Vladimir Bobic.

Site last updated on: 28 March 2014

Disclaimer: This website is a source of information and education resource for health professionals and individuals with knee problems. Neither Chester Knee Clinic nor Vladimir Bobic make any warranties or guarantees that the information contained herein is accurate or complete, and are not responsible for any errors or omissions therein, or for the results obtained from the use of such information. Users of this information are encouraged to confirm the accuracy and applicability thereof with other sources. Not all knee conditions and treatment modalities are described on this website. The opinions and methods of diagnosis and treatment change inevitably and rapidly as new information becomes available, and therefore the information in this website does not necessarily represent the most current thoughts or methods. The content of this website is provided for information only and is not intended to be used for diagnosis or treatment or as a substitute for consultation with your own doctor or a specialist. Email addresses supplied are provided for basic enquiries and should not be used for urgent or emergency requests, treatment of any knee injuries or conditions or to transmit confidential or medical information. If you have sustained a knee injury or have a medical condition, you should promptly seek appropriate medical advice from your local doctor. Any opinions or information, unless otherwise stated, are those of Vladimir Bobic, and in no way claim to represent the views of any other medical professionals or institutions, including Nuffield Health and Spire Hospitals. Chester Knee Clinic will not be liable for any direct, indirect, consequential, special, exemplary, or other damages, loss or injury to persons which may occur by the user's reliance on any statements, information or advice contained in this website. Chester Knee Clinic is not responsible for the content of external websites.

[ back to top ]

Click here for a printer friendly version