Publications by authors named "Paul M Sutton"

7 Publications

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Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis.

Am J Sports Med 2021 Sep 15:3635465211036141. Epub 2021 Sep 15.

School of Medicine, University of Central Lancashire, Preston, UK.

Background: After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear.

Purpose: To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis.

Study Design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: Two reviewers independently performed systematic literature searches of 5 online databases using the Cochrane methodology for systematic reviews. Eligibility criteria were any comparative study of patients aged >16 years that assessed the relationship between timing of primary ACL reconstruction surgery and rates of chondral injuries. Meta-analysis was conducted using a random-effects model.

Results: After screening, 14 studies (n = 3559 patients) out of 2363 titles met the inclusion criteria: 3 randomized controlled trials (n = 272), 3 prospective cohort studies (n = 398), and 8 retrospective cohort studies (n = 2889). In analysis of the studies, chondral injury rates were compared between ACL reconstructions performed before and after 3 time points: 3, 6, and 12 months after injury (eg, ≤3 vs >3 months). The rates of chondral injury increased with each time point. The increase was mostly due to low-grade injuries at 3 months (estimated odds ratio, 1.914; 95% CI, 1.242-2.949; = .003), with the increase in high-grade injuries becoming predominant after 12 months (estimated odds ratio, 3.057; 95% CI, 1.460-6.40; = .003).

Conclusion: Our findings suggest that delaying ACL reconstruction surgery results in a higher rate of chondral injuries and the severity of these lesions worsens with time. These findings are comparable with those of our previously published study, which demonstrated a higher risk of meniscal tears associated with delayed ACL surgery. When ACL reconstruction is indicated, surgery ≤3 months after injury is associated with a lower risk of intra-articular damage.

Registration: CRD42016032846 (PROSPERO).
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September 2021

Uncemented tantalum metal components versus cemented tibial components in total knee arthroplasty: 11- to 15-year outcomes of a single-blinded randomized controlled trial.

Bone Joint J 2020 Aug;102-B(8):1025-1032

Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.

Aims: Total knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design.

Methods: Patients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m (21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up.

Results: At final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001).

Conclusion: Use of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: 2020;102-B(8):1025-1032.
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August 2020

Management of intraoperative complications in arthroscopic primary anterior cruciate ligament reconstruction.

J Knee Surg 2015 Apr 21;28(2):165-74. Epub 2014 Apr 21.

Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield, United Kingdom.

Arthroscopic anterior cruciate ligament reconstruction is a commonly performed procedure which is technically demanding and involves multiple surgical steps with the potential for a wide range of intraoperative complications. In this article, we review these potential complications and give algorithms for dealing with them based on our experience and published evidence. We discuss the use of both bone-patellar tendon-bone and hamstring grafts and examine complications associated with suspensory button and interference screw fixation.
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April 2015

A biomechanical study comparing two fixation methods in depression fractures of the lateral tibial plateau in porcine bone.

BMC Sports Sci Med Rehabil 2013 Aug 30;5(1):15. Epub 2013 Aug 30.

Department of Orthopaedics, Sheffield Teaching Hospital NHS Trust, Herries Road, Sheffield S5 7AU, UK.

Background: A novel method of fixation has been described for the treatment of pure depression fractures of the lateral tibial plateau. Fracture fragments are elevated through a reamed transtibial tunnel. An interference screw is then passed into the tunnel to buttress fracture fragments from beneath. This method of fixation has perceived benefits but there have been no studies to demonstrate that the technique is biomechanically sound. The aim of our study is to compare traditional parallel, subchondral screw fixation with the use of an interference screw, assessing maintenance of fracture reduction following simulated post-operative loading, and overall construct strength.

Methods: Depression fractures of the lateral tibial plateau were simulated in 14 porcine knees. Fracture fragments were elevated through a reamed transtibial tunnel and samples were randomly assigned to a fixation method. 7 knees underwent traditional fixation with parallel subcortical cannulated screws, the remainder were stabilized using a single interference screw passed through the transtibial tunnel. Following preloading, each tibia was cyclically loaded from 0 to 500 Newtons for 5,000 cycles using a Nene testing machine. Displacement of the depressed fracture fragments were measured pre and post loading. Samples were then loaded to failure to test ultimate strength of each construct.

Results: The depression displacement of the fractures fixed using cannulated screws was on average 0.76 mm, in comparison to 0.61mm in the interference screw group (p=0.514). Mechanical failure of the cannulated screw constructs occurred at a mean of 3400 N. Failure of the transtibial interference screw constructs occurred at a mean of 1700 N (p<0.01). In both groups the mechanism of ultimate failure was splitting of the tibial plateau.

Conclusion: These results demonstrate the increased biomechanical strength of parallel, cannulated screws for depression fractures of the tibial plateau, however the use of a transtibial interference screw may be a viable method of fixation under physiological loads.
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August 2013

The young osteoarthritic knee: dilemmas in management.

BMC Med 2013 Jan 18;11:14. Epub 2013 Jan 18.

Department of Trauma and Orthopaedics, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Herries Road, Sheffield, S5 7AU, UK.

As a result of increasing life expectancies, continuing physical careers, lifestyles into later life and rising obesity levels, the number of younger patients presenting with osteoarthritis (OA) of the knee is increasing. When conservative management options have been exhausted, the challenge for the orthopedic surgeon is to offer a procedure that will relieve symptoms and allow a return to a high level of function but not compromise future surgery that may be required as disease progresses or prostheses fail and require revision. We discuss the options available to this group of patients and the relative benefits and potential negative points of each. Total knee replacement (TKR) in the young patient is associated with high risk of early failure and the need for future revision surgery. After TKR, most surgeons advise limitation of sporting activities. If osteoarthritis is limited to only one compartment in the knee there may be surgical options other than TKR. Osteotomy above or below the knee may be considered and works by redirecting the load passing through the joint into the relatively unaffected compartment. A unicompartmental knee replacement (UKR) or patella-femoral joint (PFJ) replacement only replaces the articular surfaces in the affected compartment, leaving the unaffected compartments untouched with better preservation of the soft tissues. Which of these options is best for a particular patient depends upon the patient's symptoms, precise pathology, lifestyle, and expectations.
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January 2013

Anatomical single bundle anterior cruciate ligament reconstruction.

Curr Rev Musculoskelet Med 2011 Jun;4(2):65-72

The Northern General Hospital, Sheffield University Teaching Hospitals NHS Foundation Trust, Sheffield, UK,

We present a review of the literature looking at the anatomy of the Anterior Cruciate Ligament, the biomechanical aspects of ACL reconstruction, review the outcomes of single and double bundle ACL reconstruction and present the current techniques for anatomic single bundle reconstruction.
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June 2011

Bioreactor configurations for ex-situ treatment of perchlorate: a review.

Paul M Sutton

Water Environ Res 2006 Dec;78(13):2417-27

PM Sutton & Associates, Inc., Enfield, New Hampshire 03748, USA.

The perchlorate anion has been detected in the drinking water of millions of people living in the United States. At perchlorate levels equal to or greater than 1 mg/L and where the water is not immediately used for household purposes, ex-situ biotreatment has been widely applied. The principal objective of this paper was to compare the technical and economic advantages and disadvantages of various bioreactor configurations in the treatment of low- and medium-strength perchlorate-contaminated aqueous streams. The ideal bioreactor configuration for this application should be able to operate efficiently while achieving a long solids retention time, be designed to promote physical-chemical adsorption in addition to biodegradation, and operate under plug-flow hydraulic conditions. To date, the granular activated carbon (GAC) or sand-media-based fluidized bed reactors (FBRs) and GAC, sand-, or plastic-media-based packed bed reactors (PBRs) have been the reactor configurations most widely applied for perchlorate treatment. Only the FBR configuration has been applied commercially. Commercial-scale cost information presented implies no economic advantage for the PBR relative to the FBR configuration. Full-scale application information provides evidence that the FBR is a good choice for treating perchlorate-contaminated aqueous streams.
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December 2006