In the spring of 2020, six medics from Oxford, England, published a paper in the British Bone & Joint Journal. The results of their research into ‘Paediatric and adolescent anterior cruciate ligament reconstruction surgery’ were startling: analysis of 16,125 ACL reconstructions in NHS hospitals in the UK between 1997 and 2017 showed that rates of ACL surgery in the child and teenage population had increased 29-fold in the 20-year period.
At the Royal Berkshire Hospital in Reading, under an hour from Oxford, Nev Davies was shocked at the scale of the increase but not entirely surprised. As a consultant orthopaedic surgeon in both the NHS and private sector, Nev had already noticed a year-on-year increase in the number of children coming into his practice with significant knee injuries.
“I’m a consultant 14 years now and I’ve done hundreds and hundreds of ACL reconstructions,” says Nev, whose work spans both paediatric orthopaedics and adult knee surgery. “I’ve done loads more in 10, 11, 12 year-olds in the last few years; the youngest patient I’ve had was a seven year-old. It really worries me because it never used to be like that, not when I was training.”
Nev believes there are multiple factors playing into the increase in youth knee injuries. Young people are generally less active in their day-to-day lives than previous generations, resulting in less of what he calls “natural strength and conditioning”. Sports are often experienced only in organised, competitive environments, where activity goes from zero to 100%. The rise in popularity in women’s football in the UK, meanwhile, has contributed to more girls playing high-intensity sport, possibly for the first time.
“The evidence we know about is that kids are generally deconditioned,” Nev explains. “An ACL injury, essentially, is a pivot. So, you shift your leg and your muscle control isn’t strong enough to control the leg, and it twists and pops.”
Nev doesn’t mince his words on what an ACL injury means in a young person. Injuries in young athletes usually require a surgical reconstruction because the ACL rarely recovers enough for the knee to be sufficiently stable to resume ‘pivoting’ sports. Surgeons typically use a hamstring graft to make a new ligament across the knee, a procedure that sometimes also involves dealing with cartilage tears.
“Patients are on crutches for about two weeks but then they start a long and hard period of rehabilitation with a physiotherapist,” says Nev. “I don’t let my patients return to contact sports for 12 months from the date of surgery, to minimise their chances of re-rupture.
“So, even if we can reconstruct that ligament and patch them up, this is an injury that affects not just their physical health but their mental health, their academic health, their social health. The other problem is that a good proportion of young people with ligament injuries end up with early knee problems in middle age.”
Not content to sit back and watch the numbers rise, Nev is now one of the main people in the UK flying the flag for injury prevention. In 2021, he became a trustee of Power Up To Play, a charity set up by medical professionals to improve player welfare in grassroots sports by preventing serious knee injuries. It champions a 10-12 minute warm-up – “preactivation” – programme for young athletes that, when performed regularly, can reduce injuries in individuals by 50%-70%.
“The stats are phenomenal,” says Nev. “Even something as simple as a balancing exercise; over a period of eight or ten weeks, you’re going to see a difference in your leg strength. I say to people all the time: ‘If you brush your teeth every day, you will have healthy teeth. If you do your knee exercises every day, you’re going to have healthy, strong knees for the future.’”
Power Up To Play has been making inroads at grassroots club level and now has about 85 ‘ambassadors’ giving education and information sessions to youth coaches. The charity has good attendances at coaching events in England and Wales and has landed a collaboration with the Welsh Football Association (FA), which includes writing an injury prevention learning module for its Level 1 coaching badge. Nev is hopeful that early conversations with the English FA will develop into something meaningful.
“We’ve made some good progress locally,” he says. “We’ve approached coaches first because we think kids will listen to their coaches,” he says. “Our message is: ‘If you do this, then a) you’ll reduce injuries, and b) your kids will be better athletes. There’s also evidence that your teams end up winning more. That’s how you sell it to coaches and kids. As we gain a bit more momentum, it opens other doors.”
Power Up To Play featured prominently on Sky Sports News in 2023, including some “terrifying” live TV time for Nev. He has also visited injury prevention initiatives in other countries, including Norway’s Skadefri programme, which has funding from sources including a Norwegian bank, allowing it to employ full-time staff and people to deliver the coaching. Similar funding would be a game-changer for Power Up To Play, according to Nev.
“It would be fantastic to have funding to employ some kind of central coordinator. The difficulty is we’re all full-time clinicians. We all chip in but it is challenging and time consuming. Preventative medicine is not high priority but if the government invested a little bit in this, they would save millions going forward.”
Nev says “knees and kids” have interested him from early on in his medical career. “In general, kids, because they’re growing, heal very well and bounce back from whatever is thrown at them. They’re very resilient. Being able to meet a child when they’re young and follow them through until they finish growing is the best thing about my job.”
Though he grew up in Worcester in England’s West Midlands, his mother and her parents spoke fluent Welsh in the family home. As a student at St Mary’s Hospital Medical School in Paddington, he met his now wife, Lauren.
Lauren played international hockey for Wales and also represented Great Britain at triathlon for many years. A consultant anaesthetist at Royal Berkshire Hospital, she is a keen Ironman athlete and also coaches kids’ rugby. “Lauren is a very impressive person. Her life is military organised in terms of getting all her training done,” says Nev proudly.
After his medical degree, Nev did a three-year basic surgical rotation at hospitals around London, followed by six years on the Oxford Specialist Registrar Rotation in trauma and orthopaedics. In 2009, he did a fellowship in children’s orthopaedics at The Children’s Hospital at Westmead in Sydney, commonly known as Westmead Kids.
“When I came back, I worked for Richard Dodds, who was my mentor. He’s a knee-world legend and a hero of mine,” says Nev. Outside the medical world, Richard is also known as the captain of the Great Britain hockey squad that won gold at the 1988 Summer Olympics in Seoul.
Nev secured a local post as a consultant and was quickly embedded in paediatric fractures. With John Morley, a Scottish orthopaedic surgeon who was appointed at Royal Berkshire Hospital around the same time, they developed a virtual fracture clinic in Reading modelled on one in Glasgow. The pioneering new clinic was built on virtual clinic software from Bluespier, a Clanwilliam company that supplies theatre management systems and clinical software solutions to more than 60 NHS and private hospitals.
“That was a massive technological advancement in the way that we did things. It just streamlined care,” says Nev. “We were in a situation where the hospital system was saturated but it was often saturated with the wrong people being in the wrong place and getting very frustrated. The virtual clinic created this signpost to direct patients to the most appropriate point of care, which benefited their patient journey. It was quite pioneering and we’ve had lots of other departments coming to visit us and use our model.”
He currently spends about 70% of his time on NHS work and 30% private work. He uses practice management software from DGL, also part of Clanwilliam, to manage a busy calendar of consults and surgery. “My secretary uses DGL to manage the practice and run everything between two sites,” he says. “She is very forward-thinking and uses all the technology to the best of our advantage.”
The flexibility facilitated by technology allows Nev to build time into his working week to watch his three sons play their many sports. He is the club welfare officer for local kids’ football team and coaches rugby and cricket in season. He finds time for golf when he can, often accompanied by one of the family dogs.
Injury prevention and an effective warm-up are never far from his mind. Nev makes the comparison with people wearing helmets for snow sports, something that was rare 20 years ago but is now ubiquitous. “The vision is for our charity not to exist in the future because injury prevention has become a natural and integral part of sport,” says Nev. “It’s frustrating when it’s such a simple thing, a no-brainer, and you end up hitting brick walls. But that inspires us even more.”
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