JoNova

A science presenter, writer, speaker & former TV host; author of The Skeptic's Handbook (over 200,000 copies distributed & available in 15 languages).



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Consensus on human knee ligaments was wrong – new ligament found

How much don’t we know? This week doctors announce that yes, really, there is a whole ligament in the human knee that we didn’t know about, and it’s not a small one tucked away but a mid-size one and “hidden” on the outside of the knee. They’ve named it the anterolateral ligament (ALL), and it does matter if it fails, people’s knees collapse suddenly. “Only” 97% of people have one. But how is this, it was first postulated by a surgeon in 1879, and took 134 years to find. For much of that time you might have been told there was a consensus on knee anatomy, and because thousands of doctors have done knee surgery and knee replacements are now de rigeur, you might have thought the science was settled.

Sorry about the graphic photo, but when I saw that headline, I thought this would be a tiny artifact. You need to see it to appreciate just how remarkable it is that this has been missed for so long. UPDATE: It’s so remarkable, I find Chrism comments below are useful #5, #8, #12, and quite possibly the ligament was known by another name, or associated with a different malady. Is it possible that doctors have missed it completely or more likely that the PR-team are exaggerating? I’ll go with “b”. Still the point about settled science remains the same. Now there is another point too — how our funding systems encourage sensational PR rather than careful analysis.  – Jo

Blue label and arrows point to the newly discovered ALL ligament.

*This photo probably exaggerates the size of the ALL — there is another shot in the paper which makes it easier to understand how it might have been overlooked. Scroll through the comments (sorry it’s another gory shot).

New Ligament Discovered‬ In the Human Knee

Nov. 5, 2013 — Two knee surgeons at University Hospitals Leuven have discovered a previously unknown ligament in the human knee. This ligament appears to play an important role in patients with anterior cruciate ligament (ACL) tears.‪ Despite a successful ACL repair surgery and rehabilitation, some patients with ACL-repaired knees continue to experience so-called ‘pivot shift’, or episodes where the knee ‘gives way’ during activity. For the last four years, orthopedic surgeons Dr Steven Claes and Professor Dr Johan Bellemans have been conducting research into serious ACL injuries in an effort to find out why. Their starting point: an 1879 article by a French surgeon that postulated the existence of an additional ligament located on the anterior of the human knee.

That postulation turned out to be correct: the Belgian doctors are the first to identify the previously unknown ligament after a broad cadaver study using macroscopic dissection techniques. Their research shows that the ligament, which was given the name anterolateral ligament (ALL), is present in 97 per cent of all human knees. Subsequent research shows that pivot shift, the giving way of the knee in patients with an ACL tear, is caused by an injury in the ALL ligament.

Some of the conclusions were recently published in the Journal of Anatomy. The Anatomical Society praised the research as “very refreshing” and commended the researchers for reminding the medical world that, despite the emergence of advanced technology, our knowledge of the basic anatomy of the human body is not yet exhaustive.

‪The research questions current medical thinking about serious ACL injuries and could signal a breakthrough in the treatment of patients with serious ACL injuries. Dr Claes and Professor Bellemans are currently working on a surgical technique to correct ALL injuries. Those results will be ready in several years.

‪ACL tears are common among athletes in pivot-heavy sports such as soccer, basketball, skiing and football.

REFERENCE

Claes, S., et al (2013). Anatomy of the anterolateral ligament of the knee. Journal of Anatomy, 2013; 223 (4): 321 DOI: 10.1111/joa.12087 [Abstract]

 Source: Press release Ku Leuven

H/t Science Daily

 

UPDATE:

Just to elucidate exactly what was discovered here, I searched and after I posted this, the story has been picked up by mass media (like Skynews, and the BBC). Live Science has interviewed Dr Claes who adds more detail:

“The anatomy we describe is the first precise characterization with pictures and so on, and differs in crucial points from the rather vague descriptions from the past,” Claes told LiveScience. “The uniqueness about our work is not only the fact that we identified this enigmatic structure for once and for all, but we are also the first to identify its function.” The researchers presented their new work this March at the American Academy of Orthopaedic Surgeons meeting in Chicago.

The BBC says some doctors were “blown away” while others say it may not make much difference to treatment:

Dr Claes and Bellemans think an injury to the anterolateral ligament (ALL) may be partly responsible for this. They hypothesise some people may injure the ALL at same time as the ACL, leaving the knee less stable as the leg rotates.

And their biomechanical studies suggest tears in this ligament may also be to blame for small fractures that have previously been attributed to ACL injuries.

Mr Paul Trikha, a knee surgeon at the Surrey Orthopaedic Clinic, who was also not involved in the research said: “I do around 150 ACL repairs each year. When I saw Dr Claes’ research, it blew me away.

“Knowing about the ALL has given us a better understanding of what other structures may be damaged during this common injury and this will hopefully open up opportunities to improve surgery for our patients.”

But reaction to this work has been mixed.

Gordon Bannister, professor of orthopaedics at Bristol University said: “There is no doubt this is a very interesting paper from the anatomical point of view but at the moment this is not a major clinical breakthrough. “Its role in knee injuries is a perfectly reasonable hypothesis to test but the most important step is to see whether any intervention to the ligament actually makes a significant difference to patients.”

Abstract

In 1879, the French surgeon Segond described the existence of a ‘pearly, resistant, fibrous band’ at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as ‘(mid-third) lateral capsular ligament’, ‘capsulo-osseous layer of the iliotibial band’ or ‘anterolateral ligament’, and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond’s ‘pearly band’, hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy’s tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.

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153 comments to Consensus on human knee ligaments was wrong – new ligament found

  • #
    Bulldust

    Makes you wonder what surgeons thought the ligament was … superfluous tissue, an appendix of the knee? 97% of climate scientists have one? Oh wait, misread :D


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    • #
      Winston

      It was hiding in plain sight.


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      Rereke Whakaaro

      This may be just a simple case of changes to nomenclature, with the ever present desire to specificity.

      At the leftmost end (in the picture) there is only one connection to the bone. But is is then divided to have two connection at the rightmost end.

      We refer to a hand as a generality for the palm and all the fingers. We then have names for each of the fingers (and the thumb), but they are still collectively a hand.

      So, right now, there is an opportunity for an enterprising young surgeon to make a name for themselves by naming the lower branch of the ligament, therefore reserving the previous name for the combination of the entire structure.


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    • #
      Sean

      Maybe the missing ligament was hiding in the ocean, like everything else apparently is…


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  • #

    Yes Jo, but climate science is special, its so settled that disagreement with one single word of the latest IPCC report makes you an enemy of humanity, probably in the pay of big oil, as well as being a loony conspiracy theorist who believes the moon landings were faked.


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  • #

    Hmm..”science advances in one field therefore we can reject advances in science in a different field”?

    This would be funny if it wasn’t … no, it *is* funny.


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    • #
      Winston

      The science of Anatomy is considerably more certain than Climate science by orders of magnitude, and yet even the apparently obvious in this more “certain” area of scientific discourse can be overlooked by those who are too entrenched in their paradigm to see it. Climate, being considerably more complex with much more difficult to quantify parameters than Anatomy is hardly likely to be quite so “certain” as it is portrayed given the magnitude of what we do not yet know, let alone all the known factors that we don’t fully understand.

      I know you don’t find it easy to connect the dots, Margot, so I thought I would do it for you. Hopefully you can grasp it now.


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    • #
      Brett

      I can’t find the line you are quoting


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      • #
        Rereke Whakaaro

        Margot never lets the facts get in the way of a good jibe. That is why she is so entertaining.


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        • #
          AndyG55

          Entertaining in a “worst home videos” kind of way…..

          oop wrong person…….. but same thing….
          .
          .
          .

          Sorry, got trapped at a friend’s place last night, and that’s what his 7 and 8 year old kids were watching. ! :-(


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    • #
      AndyG55

      If you really mean that, why do you reject all the advances in climate science that show that temperature sensitivity to CO2 is basically zero and that raised CO2 levels are nothing but beneficial to the environment ?

      Also that NONE of the fixes to the no-existent problem called climate change are in fact way more environmentally and economically a plague than any amount that CO2 can ever get to in the atmosphere.

      You still cling like a slug to the warmist meme, and then make silly childish comments like that.

      Seriously, you really need to grow up and get some decent science education.


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      • #
        Rereke Whakaaro

        Andy,

        Margot is a spin doctor. She lives in a different reality, and can only communicate with us when the ninth and eleventh dimensions of hyperspace intersect on a Thursday.


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        • #
          AndyG55

          I used to seriously worry about people like him, existing with only a semi-operable brain, and zero attachment to reality.

          But in his case… nah.. let them suffer.


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    • #
      Tim Hammond

      No, science is never settled, thus we should never claim that science is settled.

      Do you see?


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  • #
    MartinX

    I thought you were using “human knee ligament” as some sort of weird metaphor. But there it is. Kinda big – makes you wonder how they missed it. Orthopods – if it’s smaller than a femur, they don’t want to know.


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  • #
    chrism

    well, it is nice to see ongoing basic research being done, i do think that this represents a slight oversell though,

    if you read Jack Hughston’s work JBJS American 70′s 80′s, he gave great credence to the anterolateral rotary stabilising tissues,
    the iliotibial band is also important, and for a long time people reconstructed this area, with ITB split slips
    to produce an ER (anti pivot external rotation force on the tibia) component in extension,

    (I stopped doing this in about 1999 as it is mostly unnecessary)

    unfortunately the little blip you see here is the tip of a very large iceberg (ACL research and anatomy and surgery)
    fortunately it is a relatively settled science (hamstrings are the best reconstructive source) (no they’re not : patella tendon is) (no its not, artificial is best)………

    I am having the near equivalent to a considered climate debate with myself here in ACL terms

    I include a recent reference (below) which refers to the Segond lesion , which I think is the likely attachment point of this ‘new’ ligament

    (I don’t have Segonds original paper, but I am willing to bet 50 cents he had very nice diagrams of this part of the knee,
    and had a pet French name for this area -

    a better analogy/metaphor for the climate debate mapping to anatomy’s history as a science might be the religious and governmental interdiction against latter day anatomists
    which led to gruesome behaviours and wonderfully colourful vignettes about how surgeons and anatomists thwarted the authorities
    doing illegal acts to bring new knowledge into (sometimes forgotten knowledge that was lost during the ‘Dark’ Ages) being

    J Orthop Traumatol. 2008 September; 9(3): 167–169.
    Published online 2008 August 16. doi: 10.1007/s10195-008-0026-2
    PMCID: PMC2656983
    Segond fracture with anterior cruciate ligament tear in an adolescent
    F. Falciglia,corresponding author1 G. Mastantuoni,1 and V. Guzzanti1,2
    Over a century ago, in 1879, Segond [1] described a small fracture located on the tibial lateral capsular ligament insertion and posterior to Gerdy’s tubercle. Segond produced this avulsion fracture fragment experimentally by applying traction forces to the anterolateral ligamentous compartment (by internal rotation of the tibia with the knee flexed). From a clinical point of view, this fracture is important, as it is often combined with other injuries: tear of the anterior cruciate ligament (ACL) at the site of femoral attachment, avulsion fragmentation of the fibular collateral ligament at its distal attachment, and, more rarely, sprain of the tibiofibular joint. Although the first radiographic observation of the so-called Segond’s fracture dates back to 1936 [2], it is only recently [3–7] that the importance of identifying this fracture with an X-ray has been emphasized, in order to ensure a more accurate assessment of the external instability of the knee.


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    • #
      papertiger

      I’d characterize it as the squelching of scientific endeavor, with a 134 year trail of undiagnosed knee damage, by a dogmatic consensus of holymen, being finally brought to an ignoble end.


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  • #
    Safetyguy66

    Listening to Radio National on the way in to work this morning (as you do). The announcer was having a laugh at people who panicked over Y2K and he stated that “we humans always seem to get wound up over things to the point we think the world is going to end, then as usual, nothing happens”

    I laughed so hard to hear these words coming from someone on the ABC I nearly crashed the car. I mean the chances this guy is an AGWist are about 98% seasonally adjusted, yet I doubt he, like any of them, has been able to join the very simple dots between those 2 points of view and question themselves on the shrill alarmism of their chosen faith of AGW.

    Peak oil = garbage
    Club of Rome starvation by 1990 = garbage
    Everyone dying of aids or H1N1 = garbage
    Everyone being killed by Bin Laden = garbage

    Its almost fair to say that if you see a mass of people running from something these days, go in the opposite direction because chances are those lemmings are headed for the cliff.

    As I have mentioned before (directly relates to Jo’s post) who would have thought we would find a new species of great cat as late as 2006?, yet here it is

    http://cloudedleopard.org/default.aspx?link%3dabout_main

    We know so little about this planet and its workings. Anyone who tells you they are certain needs to take a reality check. This is science certainty…

    http://youtu.be/7hYaPnkGTLM

    If you cant replicate it accurately, your guessing pal. Guessing is fine, but realise and admit your guessing rather than trying to pass it off as a “fact”.


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  • #
    handjive

    “The object of life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane.”
    Marcus Aurielius

    Marcus Aurelius was a Roman Emperor from 161 to 180.
    He ruled with Lucius Verus as co-emperor from 161 until Verus’ death in 169.
    He was the last of the Five Good Emperors, and is also considered one of the most important Stoic philosophers.


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    • #
      Safetyguy66

      “Being curious may bring you back to the conventional wisdom, or it may not; but at least you’ve arrived there of your own accord and not just followed the crowd. Be a sceptic, a contrarian, an iconoclast even, if you have the where-with-all for it. Most don’t, so it will never be a crowded field.” Neville Kennard 1937-2012


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      maltesertoo

      Marcus Aurelius was probably seeing the rise of the insane who were getting powerful and popular but whose policies and politics eventually caused the fall of that great empire.
      I see lots of parallels today.


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  • #
    chrism

    here is another paper abstract that shows , to me, this is old news resuscitated,
    I haven’t read either of the new or this old paper in full, it’s just that I am skeptical that this is actually not a new discovery

    Radiology. 2001 May;219(2):381-6.
    Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion.
    Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D.
    Source
    Department of Radiology, Veterans Affairs Medical Center, University of California, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.

    Abstract
    PURPOSE:
    To demonstrate the normal anatomy of the stabilizing structures of the lateral aspect of the knee and to investigate pathogenesis of the Segond fracture, with emphasis on the iliotibial tract (ITT) and anterior oblique band (AOB) of the fibular collateral ligament.
    MATERIALS AND METHODS:
    Dissection of the region of the AOB, ITT, and lateral capsular ligament was performed in three cadaveric knees, with placement of gadopentetate dimeglumine-filled tubes along their course and tibial insertions. These knees, in addition to three nondissected knees, were studied with magnetic resonance (MR) imaging by using standard and specialized oblique planes. Specimen sectioning provided anatomic correlation. Retrospective review of radiographs and MR images in 17 patients with acute Segond fractures was performed, and the relationship between the fragment and the demonstrated lateral supporting structures of the knee was noted.
    RESULTS:
    Anatomic dissection and MR imaging of the cadaveric knees demonstrated a broad tibial insertion of the ITT, with fibers extending posterior to the Gerdy tubercle. A firm band of tissue, the AOB, extended from the fibular collateral ligament to the midportion of the lateral tibia, the typical site of a Segond fracture. The lateral capsular ligament proved to be a mere thickening of the capsule, inserting at the lateral tibia. Clinical analysis of acute Segond fractures confirmed the frequent attachment of the ITT and AOB to the avulsed fragment.
    CONCLUSION:
    Anatomic and clinical findings suggest that fibers of the ITT and AOB are important factors in the pathogenesis of the Segond fracture.


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  • #
    Sunray

    Well spotted Jo, but Gee, you are sooo strict.


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  • #
    RoHa

    And does the anterolateral ligament cause Global Warming 97% of the time?


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  • #

    How the heck could they miss that! It’s enormous!


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      Peter C

      If you had seen the knee when the joint capsule was still there it would not have looked so obvious. Amazing what you can find by carefully disecting away all the surrounding connective tissue with a scalpel, leaving a bit behind.

      All see comments by chrism, who says the ligament already has a name, so it has not just recently been found.


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      Yonniestone

      If you think that’s enormous, I bet your a happy man. ;)


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    chrism

    perhaps I need to be more certain
    star comment

    ok : the anterior oblique band of the Lateral collateral ligament is what these chaps seem to have discovered (again)

    It looks to me like the report by the news team is a “gotcha” story for those silly doctors and anatomists that have been doing anatomy since Celsus
    except the ‘gotcha’ I think is rubbish

    the ligament already has a name (AOB of LCL) –

    it was clearly described in the 2001 article, and it at least functionally, was known by Segond in 1879
    and people did go through a treatment phase for this lesion in the 70′s and that was revived briefly in the 90′s (and I was one that treated this aspect for a decade, in some knees, – but mostly it isn’t required : complex issues : look at AJSM 1990-2000)

    so, the caveat here is I haven’t read exactly what they have said, not can I find a copy easily of Segonds 1879 article, so perhaps there may be something new, but I suspect not
    why has the journal published this ?
    my guess is the actual nitty gritty varies in some way as to the directions of the fibres and the previous emphasis on the ITB attachment and the capsular tissues in this area

    with regards to the ‘obviousness’ of anatomy vs the complex chaotic multivariate nature of climate science, well unfortunately there is quite a bit of sculptor influence on what is found when you start digging through tissues that have multiple directions of fibres that aren’t as clearly separate as the picture would indicate, and thats why Segonds article in 1879 (a middling long time ago) is so important where this claim of ‘new’ knowledge is being made

    someone will have to trogg down to the library and apply for a copy to be sent – it may be at Melb Uni, and then also read carefully the new article to establish the veracity of this claim
    (and even then we will end up with a hair splitting debate I suspect)

    I am sceptical this represents a significant addition to knowledge about the LCL, and think it is likely mostly media beat-up and only a little new information is added, or possibly re-emphasised old information


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  • #

    Thanks for finding this Jo, it describes my problems to a Tee, I mean knee …


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  • #
    Bulldust

    O/T but one of our favourites (Johnathon Green) is banging on again at the ABC:

    http://www.abc.net.au/news/2013-11-07/green-when-grave-facts-and-political-calculation-collide/5076354

    He keeps on and on about the “facts” of the climate science, but he seems oblivious to what they are. My response to his lack of facts:

    Odd really … I see the “facts of the science” or words to that effect stated several times, but no indication wahtsoever what these alledged “facts” are.

    Could it be that facts like the insignificant change in global average temperature for at least 15 plus years fly in the face of the alarmism that the OP likes to peddle? Or the fact that the Arctic stubbornly refuses to go ice free as predicted? or the fact that floods hit eastern Australia, where damns were never to fill again from natural rains? or the fact that Antarctic ice extent increases steadfastly, despite a warming world? or the fact that polar bear populations are increasing? I could go on at length, but I guess you get the point.

    I think the fact that the public is becoming educated about the facts of climate is what has put a dampener on the sense of urgency, and hence the need for political expediency on the issue. I was a fence-sitter in the debate until I looked more closely at the evidence presented. Weighed, measured and found wanting…

    NOTE: This will be copied elsewhere, because we know what the ABC mods are like when such startements are not made, despite being well within the posting guidelines. Too many comments “moderated” too count…


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      Uncle Gus

      “Dams” not “damns”, Bulldust. Praising this with faint dams, because I don’t think the public are getting educated, they’re just suffering from alarmist fatigue. Depressing, I know, but Climate Change is just a fashion, and sooner or later it will go out of fashion. Even more depressingly, this would still be true if the alarmists were right.


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  • #

    [...] – It’s always in the last place you look. [...]


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  • #
    handjive

    It seems the French have found a new old way to reach consensus on environmental taxes.

    As the date for the implementation of a new “ecotax” on heavy road transport in France drew near – having been set in motion by the previous centre-right government under former president Nicolas Sarkozy in 2009 – mass protests broke out at the end of October.

    The protesters, on the other hand, seem to have more in mind the slogan liberté, égalité, fraternité as they are set to recreate the French revolution.


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  • #
    Kevin Lohse

    Jo, Are you absolutely certain that this paper wasn’t published on April !st?


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    Yonniestone

    It’s amazing it was missed and made me think of Andreas Vesalius http://www.britannica.com/EBchecked/topic/626818/Andreas-Vesalius of whom I have a book with his plates/drawings “De Humani Corporis Fabrica Epitome & Tabulae Sex.”, I used the book for Art in High School but the detail is astonishing for the 16th century.
    There is a poem in the book and I’ve never found out who wrote it, it’s quite beautiful.

    All splendor is dissolved by death, and through
    The snow white limbs steals Stygian hue to spoil
    The grace of form.


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    Tim

    The Nobel Prize in Physiology or Medicine for 2005 was given jointly to Robin Warren and Barry Marshall. They discovered that the bacterium: Helicobacter pylori were responsible for peptic ulcer disease.

    Up till then, stress and lifestyle were considered the major causes. These causes would have suited big pharma conveniently as they flogged their medications for many generations.

    A bit like the knee ligament story-but I think in this case there could have been a more ‘convenient consensus’ until someone actually dared to challenge it.

    Ring a bell?


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      AndyG55

      I suspect that stress and lifestyle leave you more open to ulcers, easier for the little fellas to get a hold.

      Sort of like warmism leave a person open to ridicule.


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      Mattb

      Surely a cause that has a pharmacutical cure (Helicobacter pylori) would be much more pleasing to big-pharma than one that required you to make lifestyle changes and eat healthier?


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      Safetyguy66

      Yeah I was thinking about that the other day and recalling my dad always having a pack of Qickeze and saying he needed to relax more because stress was giving him ulcers.


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    Mattb

    I’m not sure how a field of science making a discovery has anything to do with climate science? Is the suggestion nothing is ever done about anything because one day science may discover something new. Or is it that we make policy decisions based upon things science has yet to discover?


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    Bulldust

    In a heart-warming sign of how seriously the Abbott Government is taking CAGW we see that a low level delegation is being sent to the Polish climate talks:

    http://www.theaustralian.com.au/national-affairs/policy/australia-snubs-global-climate-talks-as-greg-hunt-stays-home-to-repeal-carbon-tax/story-e6frg6xf-1226754823154


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    realist

    ….. using macroscopic dissection technique…

    This means relatively large, not microscopic. Literally hiding in plain sight for those who can’t see that they cannot see. Paradigm paralysis? We are so advanced (and we are in comparison to even 50 years ago), we regard our knowledge is settled, nothing dramatic left to learn and over-turn prior thinking. Just like the copious empirical evidence that refutes climate models.

    The contemporary “sceptics” here would be well qualified Bowen practitioners (other practitioners, not-withstanding), regarded by most (if not all) in the Sickness Industry as “unqualified”, yet, it might be fair to suggest they know more about ligaments, tendons and muscles, (that is their specialty to understand as these tissues literally provide the stability and mobility in life) than the run of the mill medicos, to be also fair, simply don’t have the training or exposure to recognise the underlying issues (no, it’s not a shortage of medication).

    As for the specialists in orthopaedics (who by contrast, cut, slice, dice, replace and medicate), who rely on publications and seminars, etc for specialist knowledge, it’s a case of caveat emptor when they propose a payment for their new BMW joint replacement to “fix” the soreness in your legs and knees. Some are excellent, others are akin to a second rate mechanic doing an overhaul on your expensive car. Why hand your one and only body (and life) to someone wielding a knife to carve up your leg, without first beoming an expert on your “problem”?

    A good Bowen practitioner could probably say, what’s new pussycat? “Two sessions to help the body re-align itelf and you should be right”. Perhaps the Hippocratic Oath (paraphrased, “first, do no harm”) has morphed into a hypocritical oath when there is a lot of money to be made. Perhaps some are just “cousins” to the rent seekers in the climate industry, who prefer reward and notoriety to quality and integrity in outcomes? It’s a pity common sense and a willingness to explore alternative paradigms doesn’t prevail as it would deliver beneficial outcomes for all.

    A salient lesson in not blithely accepting the “knowledge” both of and from “authority”. The more specialised (charge more for their time), sometimes the arrogance and ignorance is thrown in for good measure when they are questioned, let alone challenged. Better to trust those with a strong sense of humility and honesty than the opposite characteristics.


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    Manfred

    You need to see it appreciate just how remarkable it is that this has been missed for so long.

    Yes, truly the ‘missing link’, the proverbial knee-dle in a hay stack!
    /sarc.

    Actually, this may be a good illustration of consensus science! There are in fact a total of six listed authors of this work namely, Steven A. Claes, Stijn Bartholomeeusen, Evie E. Vereecke, Jan M. Victor, Peter Verdonk and Johan Bellemans, not simply the two fearless clinicians Jo mentions.

    This is a surprising thread. It surprises me for a number of reasons. No reference is made here to that which is currently known of the lateral collateral ligament complex of the knee in order that a comparison may be drawn regarding what is considered descriptively original de novo identification. Is this literally ‘new’ morphology as promoted by the press (and journal?) in a blaze of desirable publicity? Or is it simply a new functional anatomical description of extant morphology, or maybe a new clinical anatomical description to extant morphology?

    Second, it surprises me because, given the apparent media hyperbole there appears a crucial omission of corroborating histological evidence. Without demonstrative histology that clearly separates the articular capsule from surrounding collections of dense fibrous connective tissue (ligaments) the findings here will remain open to question. Furthermore, a considerably greater number of specimen cadaveric knees of multiple ethnic groupings, ages and genders will be required to describe the variable morphology fully. I’m afraid 10 fresh frozen specimens just doesn’t cut it!…any more than a clutch of climate models or a seasonal weather observation reveals climate.

    Gross morphology and MRI are insufficient evidence, together with the small sample size to include this new description in a new edition of Gray’s Anatomy. As an aside, I might also add that the surprising suspension of healthy skepticism usually seen here is breathtaking. It is extraordinary. Do you consider the anatomical and medical sciences are beyond the possibility of pal review? And there’s that magical 97 per cent again, only this time ‘of all human knees’ except that there were only 10 fresh cadavers in this study.

    For me, what immediately springs to mind is that the lateral collateral ligament complex of the knee is typically and usually described as separate from the lateral meniscus. This is also consistent with my own observation in dissection and demonstration. On the other hand, this recent study describes the anterolateral ligament to be attached to the lateral meniscus. This is an important differentiation and will need to be more widely examined. It may well be an important step forward in understanding the functional, clinical, biomechanical and kinesiological characteristics of a complex joint but there’s a very long way to go yet.

    To brand the wider agreement of knee morphology as an illustration of consensus science is simply wrong headed. The anatomical sciences in particular are the beneficiaries of the recent advances in sophisticated imaging techniques, which permit re-evaluation of older descriptions. Anatomists are constantly re-defining anatomy, functional and clinical anatomy aided by modern advances in computing, imaging, 3D imaging and so on. Indeed, more often than not, it is the clinicians that take years to catch-up with the new findings or to become aware of new descriptions that may also include wide morphological variation. Anatomists of the 19th Century did not have the basic advantages of surgical stereo-microscopes with halogen lighting for example. That is an immense disadvantage when it comes to detailed morphological study.

    The full abstract for this article about the anterolateral ligament of the knee is worth a read.

    There is quite some way to go before media hyperbole meets the requirements of good evidence. Until then, I will wait until good anatomical studies with good evidence arise to confirm the findings of the clinician authors in this current study. Good science as we all so well know trumps self-absorbed hyperbole, whether of the Mannian type, the anatomical type, or indeed as appears to be suggested here, the dumb-ass consensus-delay type.


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      Manfred, thanks for your insights. You clearly know the topic well.

      Yes, the PR was over done – agreed. The photo above probably exaggerates the size of the ligament, and I’ve added a second from the paper further down in the comments which I think puts things into perspective better. The second photo gives us a much clearer picture of just how complex those structures are.

      FYI There were 41 cadavers, not 10, though still a very small sample, true, and yes 97% will have a big error margin, not that — for the sake of curiosity and a short blog post– it matters whether it was 97 or say 67%. It is still surprising (for average users of the medical system)that we don’t know our knees to such exact detail. Possibly not to you, but I think this story captures some of the sense of how much we have to learn, and how far from settled most branches of science are.

      Soon after posting I added a note pointing out that media spin was at work and pointed out: “… how our funding systems encourage sensational PR rather than careful analysis”. After I posted the large media outlets have added some more details (see the latest update above). And other specialists mirror your comment that this might be important, but it might not…

      As for the meniscus, your anatomy knowledge far exceeds mine – I note the paper says:
      “A strong connection was seen between the ALL and the periphery of the middle third of the meniscal body of the lateral meniscus, which was divided into the meniscofemoral and meniscotibial portions of the ALL, above and under the meniscal rim, respectively (Fig. 3). After sharply detaching the ALL from the meniscus, the lateral inferior geniculate artery (LIGA) and vein were invariably found, situated in between the lateral meniscal rim and the ALL at the level of the joint line.
      See fig 3 here. I don’t know that it helps you…
      Caption
      Fig. 3 Photograph of a left knee detailing the close relationship of the ALL with the lateral meniscus. ALL, anterolateral ligament; *(asterisk), meniscofemoral portion of the ALL; •(dot), eniscotibial portion of the ALL; ITB, iliotibial band; LCL, lateral collateral ligament; LIGA, lateral inferior geniculate artery and veins; LFC, lateral femoral condyle; LFE, lateral femoral epicondyle; LM, lateral meniscus.

      As far as consensus goes, I did not mean any disrespect to current expert anatomists – I was more making the point about the medical sector as a whole (and science in general). Do many textbooks and physios discuss the possibility of ligaments undiscovered?


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        Manfred

        Jo, it was late and I was running on empty. I was also unable to access the full article from my location, and was limited to your comments and the abstract, which reported:

        Methods:
        (1) The ALL was investigated in 35 human cadaveric knees; its dimensions and relation with anatomical landmarks were recorded. (2) Navigated knee kinematics were obtained from 10 fresh-frozen cadavers in the native knee, after sequential cutting of the two bundles of the ACL and the ALL respectively. (3) The aspect of the ALL was studied on MRI images of 350 ACL injured subjects. (4) Segond fracture characteristics were studied on MR images of 26 subjects and compared with the anatomical findings.

        It appears that the morphological aspect of this study included 35 knees and a further 10 cadavers provided n? knees were used for the kinematic component of the study and a further 26 subjects furnished n? knees with Segond # characteristics for MRI. It seems the prevalence of Segond # in 350 ACL injured subjects was 7.4%, assuming the # images were taken from the same group. This is not large. It is unclear whether this has anything to do with the presence or absence of the ALL. I have no idea whether this prevalence of injury is widely representative of the population at large or whether it is unique to the Belgian cohort studied. Any associational relationship between injury and the ALL remains uncertain, as the full descriptive morphology of the ALL is presently unknown.

        In anatomical studies such as this, it is critical that the results of the morphological study are not due to dissection artefact. Others will examine the work and repeat the dissection. Likely, they will also determine whether variability exists between genders, sides, ethnic groups, with age and so on. It is also quite usual for wide ranges in morphological variation to occur and the knee is no exception.

        As I mentioned previously, the lateral collateral ligament is established to be unattached to the margins of the lateral meniscus. There are functional consequences of this morphological arrangement. This paper in effect potentially identifies a new functional reason for the ALL. Traditionally, the ALL would not have been considered to be part of the lateral collateral ligament possibly because it was positioned somewhat further anteriorly and because it was attached to the lateral meniscus. Previously considered as part of the wider joint capsule, the ALL would not been ascribed the potential functional importance that is now being suggested with the aid of MRI and kinematics.

        In answer to your question Jo, the textbooks are one of the last sources to which indviduals go to examine anatomy critically. They may be useful points as most text books are, from which to learn a lingua franca, or from which to commence a review but they are usually (and it is well recognised) regurgitated material from a variety of sources and prone to the vagaries of the editors or authors. They may also misinterpret, misquote or truncate the formal literature.

        Like any thorough scientist, critical analysis will repair to the new and current literature or go back and review the early original studies. However, clinicians often rely solely on textbooks, where anatomical descriptions may vary between texts, both in depth and sometimes in nomenclature or sometimes in actual structures under discussion.

        Were I keen to evaluate the understanding of a clinician I would hope for an appreciation of the ‘usual’ description from a text book together with an appreciation of what the current literature might offer, or at least an awareness of any issues of controversy or uncertainty that might exist in the region under scrutiny or clinical relevance. Descriptive anatomy is very far from being a ‘dead’ and settled discipline. Anatomists well understand this, though clinicians may be somewhat less likely to. Anatomical knowledge is often sacrificed for other subjects deemed ‘more important ‘ in the curriculum. The upshot is that many seek postgraduate training in anatomy to prepare them for a chosen field.

        As others have commented, the significant clinical anatomy here requires further study, much as the anatomical study itself requires further corroboration with other lines of investigation – for example, histology. It is interesting and it may prove to be a very useful step forward, possibly in a short space of time, given the level of interest and clinical implication.

        Now, were this climate science, this new finding might well constitute settled science, and would form the official platform for all future interventions whether surgical, medical or rehabilitational. Henceforward, having assumed 97% all human knees are exactly the same as the handful of Belgian cadaveric knees in this study, we awake to a Brave New World!


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          Yonniestone

          Manfred do you know if Andreas Vesalius identified this “missed ligament” in his anatomical drawings?
          I found it hard to believe it was but figured it may be a test from our clever host, I admire your insight thank you.


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    ceetee

    I must be sceptic to the bone because I’m having a hard time believing this particular post. It’s almost as if someone is trying to set us up. It’s not as if that particular tendon is minute or perfunctory (seemingly) to the structure as a whole. How could it be missed?
    (Like all that heat I suppose).


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    Eddie Sharpe

    OT I’m afraid but Greg Hunt seems to have his priorities in order:-

    “Hunt said through a spokesman that he would be “fully engaged in repealing the carbon tax” while the [climate] conference was underway. ” –Ben Packham, The Australian, 7 November 2013

    referring to the upcoming climate conference in Poland.

    Australia is back in the driving seat, showing the way to handle Climate once again. Greg Hunt will be busy repealing the Carbon Tax while Foreign Minister Julie Bishop will be washing her hair [Sorry Julie].


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    Mark D.

    All I want to know is: Did the poor chap whose knee is in the picture (with pins and such) ever make it through his surgery?


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    Andrew McRae

    I was a warmist like you once, but then I took an arrow to the knee.

    (/gamer-joke)

    But srsly…

    The comments by chrism are quite enlightening. Sounds like nothing new here at all. What’s more pertinent in this story is it shows how specialist knowledge that isn’t routinely useful can be neglected or forgotten over decades and can then fall out of “consensus” knowledge so as to appear bizarre and new when it is rediscovered.

    Completing the analogy with climate science…. hmmm it’s a struggle but I’ll have a go!
    Well we can’t say the rediscovery of the Medieval Warm Period was entirely accidental since it was intentionally gotten-rid-of by Overpeck in CRU (ref Climategate) after the second IPCC report. Its effects in Europe were recorded in writing, paintings, and in the names of places such as the “Vine Streets” in London which were once vineyards. The culture basically forgot about this event.

    A closer analogy would be the natural 62 year oceanic cycle of warming and cooling which was known decades ago and contributed to the warming of the 1980s+1990s but its strength and longevity were still being rediscovered in the last 10 years, for example by Verdon and Franks, “Long-term behaviour of ENSO: Interactions with the PDO over the past 400 years inferred from paleoclimate records”, 2006.

    Analogy salvaged? :)


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    I will be waiting for the “hoax” to be exposed. With all the surgeries done on knees, it seems impossible to have missed a ligament the size of the “newly” discovered one. It’s just is not possible. What is more frightening is that news people are so gullible that they publish anything. I would bet I could send a news article announcing the discovery of new sub-species of Homo Sapians and get it to the front page. My favorite is that we are running out of water because it’s leaking out the ozone hole. This “discovery” of a huge very visible ligament is more brazen yet. Wow, we really are losing it aren’t we?


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    It does seem hard to believe that this could have been missed. If it is a hoax, it’s being picked up by major news outlets now. I’ve updated the post, with some more links and quotes to help figure out how much of this is real and how much is spin. The paper itself appears real (I’ve only has a brief look). There are additional photos in the paper which suggest the picture at the top may be exaggerating the size of the ligament. The BBC has Claes saying that it was an enigmatic structure and his was the first with a precise characterization.

    Here’s a photo suggesting it is smaller and could have been missed. Phew. Close your eyes.It’s a gory one.


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      Andrew McRae

      Looks like your Christmas ham arrived early, Jo? :) Plenty of crackling on that one.


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      Kevin Lohse

      Jo, if there’s one area of surgery that has had plenty of development, it’s knee surgery. The numbers of footballers, rugby players, tennis stars, cricketers etc whose careers have been saved by well-rewarded surgeons after knee ops is legion. With that in mind, I find it difficult to believe that this ligament has not been known about and operated on for many years.

      Surgery has saved many sporting careers, maybe an op. to build an Aussie RU front row will be forthcoming in time.:)


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      Brett

      I found this regarding the topic discussed at ISAKOS 2013 congress in May:
      The Segond Fracture: Just an X-Ray Clue for a Ruptured Anterior Cruciate Ligament?

      From my limited/poor understanding of the subject… it was previously identified as part of an ACL condition, but not considered as it’s own condition???

      - The knee bone’s connected to the wristwatch – Dr Nick.


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    Roy Hogue

    I hate to be a nitpicker but if only 97% of us have this ligament, what of the 3% who don’t? Do they fall down because their knees don’t work? How do they get around?

    It would appear that this ligament isn’t as critical as it’s being made out to be. And from the picture it appears that it would be too large to miss if you’re carefully dissecting a cadaver. They find nerves and trace their tiniest thinnest little branches all over the body but no one noticed this thing?

    Someone is fooling someone.


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    Check out this abstract: http://www.abstractsonline.com/plan/ViewAbstract.aspx?sKey=5405d6c2-fc80-4261-8c08-1714a85be41c&cKey=bdae0bb3-3bc1-40ab-8ad6-2dd421f5c043

    It appears it was always known or “suspected” as being there. Honestly, if my knee surgeon did not know something the size of this ALL was in my knee, I simply would not want him touching my knee. Maybe it’s just me.


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    Turnedoutnice

    Jo: you’re pulling my leg, …….. right?


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    ROM

    Finding / rediscovering this knee ligament is probably of considerable importance to all those who have and are suffering knee problems.
    But it pales to almost insignificance when compared to what has and is happening in the world of gene technology.

    The double helix structure of DNA in the public spin doctoring was “discovered” by James Watson and Francis Crick in 1953.

    Reality was that they would never have uncovered the real structure of DNA without a long list of researchers before them who had done much of the heavy lifting in what is now called genetic research.
    Foremost in importance to Watson’s and Crick’s discovery was an X ray crystallography expert in the UK, a woman in a then man’s world Rosalind Franklin who provided the X ray crystallography film of the DNA structure that Watson and Crick when looking at on the aircraft flight returning from the UK with Franklin’s crystallography films to the USA and realised that DNA could only be of a helical type structure which could match Franklin’s filmed crystallography structures.

    For many years Franklin’s major contribution to Watson’s and Cricks discovery was rarely mentioned as Franklin had died in 1958 .
    And in fact the fourth contributor to the discovery of the DNA structure, Maurice Wilkins and his role also in X-ray crystallography interpretation is almost unknown.
    Wilkins along with Watson and Crick was awarded the Nobel prize for medicine in 1962.
    Rosalind Franklin was ignored and this caused a great deal of resentment amongst many researchers in the growing field of genetic research.

    However she is now regarded as one of the three almost in place of Wilkins when it comes to the discovery of the DNA structure and has been recognised and honored posthumously for her role in the discovery of the DNA helical structure.

    For a background to the discovery of the Double Helix and the people; The DNA molecule is shaped like a twisted ladder.

    What then occurred as the genetic structure of the double helix was unravelled and researched over some 4 decades, it was eventually concluded that only about 2% of the human genome was actually the operating genetic system for human protein synthesis, the genetic structures that are the responsible bits that creates us as living entities and sentient beings.
    Thats what we were told by the genetic experts for many years.

    The rest of our gene structure, the remaining 98% of our human genome was “junk” DNA we were told for some close to 40 years for nobody could find DNA sequences that could be identified with any essential genetic systems or requirements or in fact anything of any use genetically in that 98% of “junk” DNA in the human genome.
    But science moves on.
    Now over the last less than a decade as the science moves on and without a great deal of publicity that 98% of junk in our human DNA sequences turns out to absolutely vital in that it contains the instructions on how the “useful}” 2$ protein synthesizing DNA should be cut and spliced in it’s sequences to achieve protein synthesis.

    The junk DNA is also where increasingly the source of genetically based diseases are being found. It is apparently indicating that many viral type infections, some taking decades to manifest themselves in the human body and brain may also be located or hiding.
    There is enough unknowns in the genetic DNA and RNA structures of biological life on this planet to keep genetic researchers in comfort for the next century or more.
    For more background on the discovery of the double helix structure of DNA

    The landmark ideas of Watson and Crick relied heavily on the work of other scientists. What did the duo actually discover?

    And for more information on Junk DNA and it’s critical role in our genetic systems
    FromGenetic Engineering and Biotechnology News

    Aug 2013
    What Junk DNA? It’s an Operating System
    To quote from the above;

    Their report adds to growing experimental support for the idea that all that extra stuff in the human genes, once referred to as “junk DNA,” is more than functionless, space-filling material that happens to make up nearly 98% of the genome. The paper adds to a growing body of knowledge establishing a considerable role for this material in the regulation of gene expression and its potential role in human disease.

    &
    Hidden in the remaining 98% of the genome are the instructions that tell the genes how to switch on and off in different kinds of cells. A chief goal of ENCODE has been to find those instructions and understand how they are written in the genome.

    “In essence, these instructions are organized into millions of DNA ‘switches.’ These switches consist of strings of genetic letters, maybe 100 to 200 letters long, that can be thought of as sentences made up of short DNA words. The DNA words function as docking sites for special regulatory proteins,”
    &
    Their results, the authors concluded, suggest pervasive involvement of regulatory DNA variation in common human disease and provide pathogenic insights into diverse disorders


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    StuartMcL

    Ah, more Mannian statistics.I love how they extrapolate this:

    In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule.

    to this:
    is present in 97 per cent of all human knees.


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    Bulldust

    O/T But waiting for alarmists to start associating “super” typhoon Haiyan with climate change in 3…2…1…

    http://www.smh.com.au/environment/weather/evacuations-as-super-typhoon-haiyan-hits-philippines-20131108-2x5bk.html


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      Brett

      Yes, it’s ALL part of Super-Catastophic-Apocalyptic-Mega-Global-Anthropogenic-Temperature-Embellishment.


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      ROM

      Bulldust,
      If the alarmists start up of climate change typhoons and etc, three pertinent facts.

      1 / Your reference to the SMH Typhoon Haylan article ; quote
      “The typhoon is now the strongest storm on Earth in three decades, generating winds of 313km/h and gusts of 378km/h, meteorologists are reporting”.

      2 / The typhoon, which was advancing with a giant, 600km front,

      Prior to those three decades;

      3 / Largest Tropical Cyclone Ever Recorded
      magine a tropical cyclone (hurricane, typhoon) big enough to cover about half of the Lower 48 states.

      Believe it or not, Super Typhoon Tip grew this large in the northwest Pacific Ocean to the south of Japan and to the east of the Philippines on Oct. 12, 1979.

      This image shows the size of Super Typhoon Tip compared to the western half of the United States. Credit: NOAA

      , Tip was so large that it would cover almost the entire western United States from the Canadian border to the border with Mexico.

      According to NOAA, the circulation pattern associated with Tip was about 1,380 miles [ 2220 kms] wide. That’s close to the driving distance on I-95 from New York City to the upper Florida Keys.

      Tropical storm-force winds extended out up to 675 miles [ 1290 kms ] from the center of the super typhoon.

      Typhoon Haylan IR and Visible and forecast track; http://tropic.ssec.wisc.edu/#


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    Bulldust

    In other news. the Abbott government takes the razor to the CSIRO:

    http://www.smh.com.au/federal-politics/political-news/razor-taken-to-csiro-20131107-2x4fu.html

    I wonder how long before the climate-related “research” gets kncocked on the head there.


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    Bulldust

    Dang the good news keeps on coming… free speech is to come back:

    http://www.smh.com.au/federal-politics/political-news/george-brandis-to-repeal-bolt-laws-on-racial-discrimination-20131108-2x50p.html

    Wonder if this will get through the Upper House … Labor and Greens don’t like free speech after all…


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      Rereke Whakaaro

      … Labor and Greens don’t like free speech after all…

      Perhaps Jo can find a way of charging them for it. How about a peon tax?

      peon n. a person of low social status, especially one who does work regarded as menial or unskilled; drudge.


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    Dave

    .

    Missing Knee ligaments and missing feasibility study?

    Lots of projects (181 currently) from ARENA, the Australian Renewable Energy Agency on the books. Looking through these one (only small) was granted to QANTAS for a feasibility study to produce Sustainable Aviation Fuel.

    Well the $575,000 was given on the 1st June 2012 to QANTAS and partner Shell, well I’ve searched high and low for this study and it seems Flyn van Ewijk, Group Manager, Environment & Sustainable Fuels at QANTAS gets all his SAF (Sustainable Aviation Fuel) from SkyNRG from the Netherlands. This connection is fine, but Flyn is pretty well versed in biofuels and conferences around the world. Yet I can only find a few flights by airlines worldwide that have used 50:50 or even less that have used biofuels (and most are cooking oils derived).

    But the main point is that this feasibility study to produce Sustainable Aviation Fuel is nowhere to be found. I’ve emailed Van Ewijk, and as yet no response on where this report is.

    Seems at the time Olivia Wirth and Paul Howes can create wonders with sustainable aviation fuels for QANTAS with a greasy palm, not a dicky knee.

    The GREEN ligaments parasites Kneed more money to fix the world.


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    Dave

    .

    Questions?

    Where’s Pat, I miss the RSS type news feed. Had to look up stuff myself :)

    Also news of a bushfire on Bribie Island Qld , not huge but still not good news as one of Jo’s illustrious personalities lives there. Hope everything is OK MV. Rain will arrive sometime Sunday, and get rid of the problem, but hope everything is OK until then.


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    John Brookes

    I think I mentioned it before here, but there is a distinct lack of evidence for some surgical procedures. Mainly, I suspect, because it seems bloody obvious that the surgery should work. It is also a bit difficult to double-blind trials on surgical procedures. Now you won’t catch me doubting the efficacy of appendectomies, but there is an operation done on the very body part discussed in this thread, the knee. This operation involves going into a dodgy knee, trimming bits of cartilage, and scraping away any floating debris, hopefully to make the knee work better.

    And someone did a proper trial of this surgery. All patients were anaesthetised, and had an incision made. Then half had the procedure, and the other half were just sewn up again. And lo and behold, there was no statistically significant difference in post operative knee function between the groups This was repeated later (but not double blind), with a surgical group, a do-nothing group, and a knee exercise group. The surgical group appeared to be winning at about 12 weeks, but by 12 months, they were pretty much on a par with the knee exercise group, and both ahead of the do-nothing group.

    Its good to see the scientific method applied to surgical procedures.

    BTW, I haven’t read your thread on the Catalyst Cholesterol/Statins shows. Did you come down on the side of the established medical wisdom?


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      Eliza Doodle

      Reminds be of an acquaintance who wrecked her knees from over exercising . The surgeon in Sydney was all set for operating but she decided to go home to Blighty where she came from and have it done there , where they advised her better not to bother, so she didn’t and she’s fine now a couple of years later.


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    Michael the Realist

    Wow, everytime I come back the stories get even more ridiculous and desperate. So lets follow the logic here, because we don’t know everything, we should act like we know nothing? So because there might be some things we don’t know about the climate we should ignore the 100 plus years of science, evidence, data and observations we do have?

    So following the logic to its obvious conclusion, if a person has broken there leg with the bone poking out and bleeding, we should let them bleed to death in excruciating pain because there maybe a ligmaent we have not discovered yet. Wow, I feel like brain cells are dying just visiting this site.


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      Graeme No.3

      Don’t worry about your brain cells, worry about ours as we have to wade past your inane comments to get something worth reading.


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      Rereke Whakaaro

      You obviously haven’t read the post properly, or the debate that went on in the subsequent comments, so you end up looking like an idiot. That is fast becoming your natural habitat.

      … because we don’t know everything, we should act like we know nothing?

      Why not? It is a very useful technique to discover mistakes that have been made previously, and to identify erroneous assumptions. When I looked at the cyclic nature of atmospheric CO2 concentrations, and average global temperature, as shown in An Inconvenient Truth, but without Al Gore’s commentary, it became obvious that there was a much better correlation between temperature causing increased CO2 emissions, than the other way around. And the mechanism is known – outgassing of CO2 from warmer sea temperatures. I hate to admit it, but Al convinced me to become a skeptic.

      … we should ignore the 100 plus years of science, evidence, data and observations we do have?

      Yes, if the evidence, data, and observations, might have been tampered with. There is a principle of forensic custodianship, that is used in criminal cases, to show that the evidence has not been tampered with, prior to it being presented in court. The scientific parallel to that, is to put the raw data into escrow, held by an independent and mutually trusted third party. This demonstrates that the raw data is as good as it could be, and thus any adjustments can be replicated, and corroborated. That has not happened with the climate record, and a lot of real scientists are starting to question why?


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        Michael the Realist

        So because we do not know everything you think we should do nothing. Hmm, so because we do not know everything about the human body we should throw out all of medicine? All surgical procedures because we might come up against an unfamiliar bone? The argument in the main post is ludicrous and irrelevant and shows the depth of desperation.

        In reality comparing the climate to what we know about the human body is a call to action. We do not wait until we know everything to cure a sick child, to set a broken bone, to try different methods for curing cancer, AIDs etc. Initially the treatments are expensive and don’t work as well, but then treatments and knowledge increases, economies of scale kick in, success increases…Will we ever know everything about how the human body works? Not likely, but do we stop treating, learning, investigating and curing? off course not.

        I think the analogy works quite well, don’t you?


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          Joe V.

          Would you let a Climate Scientist anywhere near your sick child ?
          Has there ever been a treatment of less proven efficacy than those prescribed for the Climate ? Burn trees , instead of coal or oil or gas .
          Is it only fools who rush in where angels fear to tread, or do they bring a lot of useful idiots along as well ?


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          AndyG55

          The treatment climate scientists seem to be using is LEACHES !!!

          And there’s plenty of them.. you included.


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          Rereke Whakaaro

          So because we do not know everything you think we should do nothing.

          They are your words, not mine. What I was responding to, was your previous statment that, “… because we don’t know everything, we should act like we know nothing?” (my emphasis).

          What a childish trick that was …

          And the rest of your analogy is then based on that trick, presumably to hide the fact that you had no answer to my pointing out the lack of custodianship in the climate record, that the rest of your excremental pontifications are based upon.


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        Michael the Realist

        Yes, if the evidence, data, and observations, might have been tampered with.

        Oh the old conspiracy argument? How sad. The old faithful catch all when you know reality is overtaking you. I thought you guys did not agree with that and would stick to the science.

        Virtually every internationally recognised scientific organisation on the planet agrees with AGW, I am not aware of one that has a statement saying it does not exist. Every continent, virtually every country, including those with pro and against AGW governments, democratic and dictatorships. That is one hell of a conspiracy, when every global data set has the same trends, the same trends in the data of hot day records over cold days, hot months over cold months, changing seasons, changing precipitation rates etc. Really, give it up, that argument is old, pathetic and unsustainable. Science has accepted the basic tenets over 20 years ago. The predictions of the IPCC, Hansen, Jones etc in the 80′s are all coming true and most worse than expected. We are having all this heat and trauma despite natural factors over the last 60 years showing a net cooling, but temps have increased 0.6 deg c. Solar down, ENSO flat, big volcanos etc. Energy is increasing in the system and moves around it, only some people refuse to look any further than a cherry picked temp trend because if you look at all the data and all the trends and all the other places energy is increasing and being used like the oceans, Arctic, glaciers etc apart from the fact that the 2001 – 2010 decade was the hottest on record, you would see how shallow and ludicrous your argument is. Also 97% of the real scientists accept the science, as well as 98% of the science itself. Every argument you put forward falls apart under actual scrutiny and common sense. But I know you will keep making up otherwise.


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          Heywood

          Does anyone else not love the sight of watermelons exploding like this?

          Bwahahaha. Poor AAD. Obviously chasing attention again.


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          Rereke Whakaaro

          I see that the previous “conspiracy theory” has now quietly morphed into “the old conspiracy argument”. An argument must be based in fact, and therefore has more veracity than a theory (which is conjecture based on an extrapolation of observations), wouldn’t you agree?

          And it is you, at comment #41.2.1, who employs the logical fallacy of an appeal to emotion, when you say, “to cure a sick child, to set a broken bone, to try different methods for curing cancer”. We are the ones sticking to the science.

          But, to address your tirade. The Conspiracy Theory was, and apparently still is, a defensive argument used by people who a) feel challenged, and b) have no real evidence to rebut charges of inadequate, or misinterpreted evidence.

          Let me take it step by step: a) Climate changes. b) Temperatures rise and temperatures fall. c) There are trends up and trends down, over time. d) We have previously been moving through a time when temperatures have been rising. e) Since the start of the industrial revolution, mankind in Europe and the USA has been releasing sequestered carbon dioxide back into the atmosphere f) There is then, a prima facie correlation between points ‘d’ and ‘e’. g) The actual causative relationship has been assumed as anthropogenic, but not proven as such. h) Scientific organisations will accept the prima facie correlation, and the causative assumption, pending more evidence, one way or the other. i) Temperatures over the last fifteen years, have not risen at the same rate as previously. j) Over the last fifteen years, the rate of increase in atmospheric carbon dioxide has not abated. k) Scientific organisations are therefore reviewing their previous positions regarding the prima facie evidence. l) This reappraisal also includes the assumption of anthropogenic causation, since that is also now looking less likely.

          Now your rant, which starts with the logical fallacy of an appeal to majority (“virtually every lemming thinks skydiving is a great idea”), and dribbles on into an appeal to statis (people said this once, so it must be true now), really says nothing about the science, which often moves with glacial speed, and often backs the wrong horse initially, only to change its collective opinion later.


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          PhilJourdan

          And in your mind, agreement equals reality?

          How many of those “organizations” have conducted their own analysis of the data to come up with those “agreements”? I will give you a hint. The number is between 0 and 1.

          So if we get enough of them to believe in the tooth fairy, that will make it a reality as well?


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        Michael the Realist

        that there was a much better correlation between temperature causing increased CO2 emissions,

        Woops, forgot this, and it cannot go unchallenged. Also a pathetic argument that fails under scrutiny. Multiple lines of evidence show that the oceans have a net uptake of carbon, so cannot be the source. Apart from the glaringly obvious that man IS EMITTING CO2, and that the increase in the atmosphere matches the amount emitted plus what is going into the oceans.

        The old, mans emissions disappear into the ether, and it is really the oceans supplying it argument, seriously? Also the ups and downs of ocean warming and cooling do not match the sustained, stable increase in CO2, you have been taken along a silly ride and don’t know how to get off.


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          Joe V.

          Why is that phrase ” Multiple lines of evidence ” so beloved of warming advocates , as if shooting you enough lines could overcome the need to scrutinise any carefully, or as if snorting enough lines if coke could make you go along with anything. Again people who use such expressions are only trying to overwhelm your own critical thinking abilities to exhort you to action on the basis of their hysteria.


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          • #
            Eddie Sharpe

            The consumers of advocacy science can quickly be spotted when they trot out these truisms in the familiar smart sounding language picked up from the likes of SkS.

            Multiple lines of distraction from the distinct lack of real evidence.


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          AndyG55

          Yes Michael, YOU have been taken along a silly ride and YOU don’t know how to get off.

          You KNOW that your gravy train is coming to an end..

          suck at it while you can……. slimo !!


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          Rereke Whakaaro

          Michael,

          You really must get a new script writer.

          I didn’t mention oceans at all, and I certainly would not mention “the ether”.

          I was commenting on the cause and effect relationship between atmospheric carbon dioxide and “global” temperature.

          But an interesting question comes to mind. What can be measured? 1) The proportion of carbon dioxide, relative to other free gasses, in the atmosphere; at a given location and specific time. 2) The temperature at a given location and specific time; 3) … ?

          The rest is all computer modelling and simulations. Hmm, food for thought …

          And while I am musing … within the measurable proportion of carbon dioxide in the atmosphere, how do you distinguish between the anthropogenic carbon dioxide, and the non-anthropogenic carbon dioxide? How do you distinguish the source? How can you definitively claim that ALL of the increase in carbon dioxide is anthropogenic. You can’t, and it is silly to presume that you can.

          So, apart from denial of the evidence, how do you account for the fact that the rate of temperature rise has markedly decreased over the last decade and a half, but the rate of increase in atmospheric carbon dioxide has shown little variation?


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      Heywood

      “Wow, I feel like brain cells are dying just visiting this site.”

      And yet you keep coming back. Like the true activist, you can’t help yourself.
      Your life must be so empty to spend your Sunday on a blog you despise where nobody cares what you have to say.

      Perhaps it’s an attention seeking disorder. Maybe you should seek psychiatric help.

      Maybe you could consult a whole team of psychiatrists and see if they can diagnose your condition. They could all vote on what they think your problem is and treat you according to the consensus.


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        AndyG55

        Sunday is obviously the only time he can go mad mushroom picking.

        Or perhaps the only day he can visit his psychotic hallucinogen supplier.

        His little weekly brain food, to feed that one lonely synapse.


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        AndyG55

        I can suggest a guy for you Michael, .. Lewendopey.. or something like..

        He’ll give you whatever opinion you want.. he won’t even need to do an examination.


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      AndyG55

      The world may have dipped its small toe in a warm puddle….

      and you and your ilk want to starve it to death, after chopping its legs off.

      Great doctoring, moron !!


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    • #

      Nice of you to return! Now there are more people to point out why your line of “reasoning” isn’t!


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    AndyG55

    Waiting until a thread looks like its old and asleep.. then comment..

    The unrealist’s way.

    Pusillanimous git !!


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      Dave

      He’s just returned from visiting 32 countries all over the world, he’s tired and cranky.

      Plus he’s working out the following:
      1. How a coal fired power station can idle at 3,000 rpm without coal (Thesis coming up)
      2. How his son can afford a house in WA.
      3. How CO2 causes bush fires on Bribie Island on Friday and then rain on Sunday.
      4. How to get to Warsaw, cause naughty TA has canceled the gravy train.
      5. How long his internet plan will last with Dodo now his job is gone.

      Give him a small break on this. Religious fever is hard to leave when you realise your GAIA is Gone.


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