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Robert Henderson was a Scottish physician who qualified Doctor of Medicine at Aberdeen in 1786. By 1792, Henderson was working in Brighton on the south coast of England. He was admitted Licentiate of the College of Physicians of London in 1793. At Brighton he probably worked as a parish doctor. In 1795 Henderson was appointed Physician to the Forces and probably served as a garrison doctor. In Brighton, he is noted as an advocate of chalybeate water therapy (i.e. mineral spring water containing iron salts). Henderson undertook basic experiments into the chemistry of mineral water and a few, very brief, clinical observations may be his. In Henderson's time, the chalybeate in question was part of the 'Wick estate' to the North West of Brighton. Today the site of the spring is located within St Ann's Well Gardens, Hove and this article briefly considers its history. Circumstances link Henderson to Sir Lucas Pepys MD (1742-1830), physician-general to the army and closely associated with both the College of Physicians and the town of Brighton. Henderson died in Brighton on the 3rd April 1808. Henderson's daughter Sophia Janet married Captain William John Thompson Hood who served at Trafalgar aged eleven., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Knee extension deficits complicate recovery from ACL injury and reconstruction; however, the incidence of knee extension loss is not well defined. The aim of this review was to identify the incidence of loss of extension (LOE) following ACL rupture and reconstruction, explore the definitions of knee extension deficits reported and identify prognostic factors affecting LOE incidence., Methods: A systematic search was conducted in Medline, Cochrane Library and PEDro for studies in publication up to November 2021, with no restrictions on publication year. References were screened and assessed for inclusion using predetermined eligibility criteria. Randomised controlled trials (RCTs) that quantified knee angle, loss of extension or incidence of extension deficit were included for quality assessment and data extraction. Statistical summaries were generated and meta-analyses performed in two parts to examine: (i) the probability of a datapoint being zero incidence compared to a nonzero incidence and (ii) the relationship between the predictors and nonzero LOE incidence., Results: A sample of 15,494 studies were retrieved using the search criteria, with 53 studies meeting eligibility criteria. The pooled results from 4991 participants were included for analysis, with 4891 participants who had undergone ACLR. The proportion of included studies judged at an overall low risk of bias was small (7.8%). The observed group and study were the most important predictors for whether a datapoint reported an incidence of extension deficit. Time to follow-up (P < 0.001) and graft type (P = 0.02) were found to have a significant influence on nonzero LOE incidence (%). Covariate adjusted estimates of average LOE indicated 1 in 3 patients presenting with LOE at 12 month follow-up, reducing to 1 in 4 at 2 years., Conclusions: This review examined the definitions for the measurement and interpretation of postoperative knee extension and established the trajectory of knee extension deficit after ACL injury and reconstruction. While factors associated with loss of extension were identified, the exact trajectory of knee extension deficits was difficult to infer due to discrepancies in measurement techniques and patient variation. On average, 1 in 3 patients may present with loss of extension of at least 3 degrees at 12-month follow-up, decreasing to 1 in 4 at 2 years. These results may be used by clinicians as an upper threshold for acceptable complication rates following ACLR. Future work should focus on LOE as a clinically relevant complication of ACL injury and treatment with appropriate attention to standardisation of definitions, measurements and better understanding of natural history., Prospero Registration Number: CRD42018092295., Level of Evidence: Level I., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

McWhinney's first principle of family medicine states that GPs 'are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique'. While indeed committed to the person, we propose that the 'special technique' of general practice exists in the form of core clinical concepts for managing uncertainty (e.g. time as a tool, therapeutic examination, safety netting and doctor as drug). Managing clinical uncertainty calls for GPs (and trainees) to operate in a 'corridor of uncertainty', a cricketing analogy where the batter is unsure whether to play a defensive or attacking shot. For students to recognise and value these concepts requires longitudinal learning and simulation. Here we describe a GP module at Brighton medical school where core concepts are 'drip fed' through small group sessions across year 4. Formative simulated surgeries constitute a 'corridor of uncertainty' where simulated patients drive students into using concepts in practice (e.g. through shared management plans). Although recognised in postgraduate training, these concepts should be taught formally within the undergraduate curriculum. Doing so helps students distinguish general practice from hospital generalism and prepares them for clinical placements in general practice. These concepts are inherently 'soft' and founded upon the GP paradigm of understanding medicine. In the eyes of the specialist, they risk being unacknowledged, misinterpreted as ignoring guidelines or, worse still, as bad medicine. Soft core concepts constitute the tools to prepare students for managing clinical uncertainty and serve to inscribe the art of medicine within the undergraduate curriculum.