Keyhole surgery is perhaps a misleading term: despite the technology, expertise and extreme finesse involved, it’s also hugely physical.
Sky News watches as surgeon Luke Jones performs an anterior cruciate ligament reconstruction in an operating theatre in King Edward VII’s hospital in central London.
Mr Jones (male surgeons are referred to as Mr rather than Dr) doesn’t just remove a hamstring: he pulls it out with force.
Drills bore through bone. Flesh smokes as it is cauterised. There’s a fair amount of hammering: “Mallet, please,” Mr Jones asks his assistant.
The ACL is a small band of tissue running through the middle of the knee that keeps it stable.
But watching the operation, it’s easy to understand why tearing it is so devastating. Even though the patient will only have three tiny scars, their knee has taken a pummelling.
“There’s 90 minutes in theatre with me,” Mr Jones tells Sky News, adding: “And then there is one year of rehabilitation with your physiotherapist afterwards.”
That’s why ACL injuries are so feared, especially by one type of athlete: female footballers.
‘Way too many’ women’s players with ACL injuries
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Between 25 and 30 players – enough for an entire extra squad – will miss the upcoming World Cup because of ACL injuries. England stars Beth Mead and Leah Williamson have been ruled out. Data from ACL Women Football Club suggests 195 elite players have suffered the injury in the last year.
It has been described as an “epidemic”. And it is an epidemic that affects women far more than men: they are 2.5 to 3.5 times more likely to rupture an ACL than a male athlete. And we don’t really know why. Even as the women’s game has boomed, research has lagged behind.
One player who is going to the World Cup is England defender Jess Carter. Speaking before departure at St George’s Park, England’s national football centre, she tells Sky News: “There’s been way too many women’s players who have had ACL injuries and not enough research that’s been done about it.
“Why are there so many injuries? How can we prevent it? Why are they happening? A question I sometimes ask is: if this was happening to high profile men’s players, would more work be going in to try and improve things?”
Nature versus nurture
The problem is that there isn’t just one answer.
“I’ve made a list the other day, and I think there are 30 reasons that have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher at St Mary’s University Twickenham and a medical researcher for FIFA.
“And I think we can split it into two main categories. And I like to call them nature and nurture.
“So the nature is like the biology: the genes, the way the body is shaped and muscle mass, etc… But also the nurture of the environment that the women are in. So the way that young female players are managed compared to male players, the facilities, the professionalism around the sport, the quality of the staff that they have available.”
I ask whether research into injuries in the women’s game has received as much attention as men’s.
“Attention? No. But generally that’s across all research in football and in sports medicine. The male has been the norm,” she adds.
Research will end up benefiting the men’s game too
Take one issue from the realm of ‘nurture’ that Kat is studying: football boots. The male foot was the norm. It’s only in recent years that boots designed specifically for women have become available. And even then we don’t understand the differences properly, which is why Kat has done 3D scans of hundreds of feet, to map them.
That research will end up benefiting the men’s game too because Kat is also charting the differences between ethnicities. Because the default foot isn’t just a man’s, it’s a white man’s.
The male is also the norm when it comes to other environmental factors, like booking a pitch.
On a Thursday evening in Kent, the Gravesham Girls and Women’s Football Club, founded in 1999, is training ahead of the start of the season. About 20 players, kitted out in yellow, are doing shooting drills and balls are flying. A Sky News camera operator cops one in the belly but bravely continues.
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Toni Allen and Keylie Oliver have both ruptured their ACL in the past. “I just screamed – everyone thought it was a fox,” Allen says. Both were out for a year.
“It’s quite daunting, and especially when you realise it’s not just football that it can impact, Oliver says.
“We have lives outside of football and it impacts that as well… At grass roots, the ladies always have a two o’clock kick-off. And that is because in our world, men’s football takes priority over women. We always have to play after – so the pitch is always ruined.”
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11:52
Women’s football: The ACL epidemic
The importance of the factors can change
Another difficulty is not just that there are lots of factors involved, it’s that the importance of the factors can change.
Professor Kirsty Elliott-Sale is professor of female Endocrinology and Exercise Physiology at the Manchester Met Institute of Sport.
She works closely with clubs, including Arsenal, to study how the menstrual cycle, or taking the Pill, can influence injuries. Research seems to suggest that some hormones can make ligaments looser, increasing the risk of rupture.
So over the course of the season Prof Elliott-Sale measures the laxity of players’ knees, charting that against their hormones, and cross referencing it with other factors like match congestion.
“It’s definitely a jigsaw,” she says. “And it’s about sort of putting all the pieces together.
“But once we have all the pieces, we don’t necessarily know which factor is going to play a bigger role on any given day. So it’s not like all of the pieces are the same size. Some days, a particular factor that might influence this type of injury might be amplified, whereas on another day, it might be turned down.”
Biology remains a large part of the answer
But even then the difference between female and male body types – which in the past led to some dismissing women as too “fragile” to play traditionally male sports – may not be as much of a factor as previously thought.
Because in some sports, the ACL injury discrepancy disappears.
“If you compare sports, where males and females start at the same age, have the same training intensity throughout their sporting life, and perform the same movements during that sport, then actually, the rupture rates equalise,” Mr Jones, the surgeon, says.
“And a very good example for that is elite dancers. So elite dance athletes, where the males and females start their training at the same age, they perform the same pivoting, jumping, twisting movements, and they have the same intensity of training and the same conditions. If you compare their rupture rates, they’re actually equalised.”
“And what that suggests is the impact of your training and your conditioning is really essential and avoiding this injury.”
Every expert I spoke to stressed the role of strength and conditioning in preventing injury. Here, nurture influences nature.
“We have that attitude of, you know, women do yoga, and pilates and men lift heavy things in the gym,” Ms Kryger says.
“But the reality is everyone needs to lift heavy things occasionally to prevent injuries and have a healthy body.”
The good news is that quantifiable progress is being made here.
Matt Whalan is a sports scientist who works with the Australian men’s and women’s football teams – the Matildas who will be competing in the World Cup. He spoke to me from the men’s under 23s camp there.
Football Australia introduced a programme called ‘Perform+’, which can be worked into warm ups, that has reduced injuries, including ACLs, by 40%.
And crucially, it’s not just for elite players.
“This is designed so that mom and dad coaches can just go online, take down the programme, all the videos are there, there’s information about how you can deliver it with your athletes, and from under-sevens through to 55-year-olds, 95-year-olds, if you want to, you can do these exercises,” Mr Whalan says.
“The benefit of that for us at the higher end level, working with national teams, is if we have players that have been doing that, since they’re 12,13,14 years old, it makes our lives a lot easier.”
That remains in the future. When the World Cup starts next week, it will do so without a host of stars.
As England forward Chloe Kelly tells Sky News: “Having suffered the ACL injury myself, it’s so sad when you see so many players suffering that injury. Hopefully, we get the research that we need to stop these injuries happening so often.”
The UK will play its “full part” in peacekeeping in Ukraine, Sir Keir Starmer has said.
The prime minister told Sky News’ political editor Beth Rigby that the conflict with Russia was not just about “sovereignty in Ukraine” but about the impact it also had on the UK, including the cost of living crisis.
Sir Keir was speaking to Sky News while on a surprise visit to Ukraine on Thursday – his first since his party’s landslide election win six months ago.
The purpose of the trip was to discuss the next steps for Ukraine, with the situation now more uncertain following Donald Trump’s election victory in November.
Mr Trump, whose inauguration takes place on 20 January, has said he wants a peace deal between Russia and Ukraine within 100 days.
But some European leaders fear pushing Kyiv into a deal could lead to Ukraine ceding some of its territory to Vladimir Putin.
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Sir Keir said he did not want “to get ahead of ourselves” but that the UK would play its “full part” in any peace negotiations – including by deploying British troops for peacekeeping.
Asked if he would be prepared to do that, the prime minister replied: “Well, I don’t want to get ahead of ourselves, but I do have indicated that we will play our full part – because this isn’t just about sovereignty in Ukraine.
“It’s about what the impact is back in the United Kingdom and our values, our freedom, our democracy. Because if Russia succeeds in this aggression, it will impact all of us for a very, very long time.”
Sir Keir said the drone threat was “a reminder of what Ukraine is facing every day” and that the war was brought about by “Russian aggression”.
Elsewhere in the interview, Sir Keir was asked about his views on Ukraine’s longstanding desire to join NATO – something President Putin strongly opposes.
At a NATO summit in Washington last summer, the alliance’s members announced that Ukraine was on an “irreversible” path to NATO membership.
“We fully support Ukraine’s right to choose its own security arrangements and decide its own future, free from outside interference. Ukraine’s future is in NATO,” the declaration said.
However, Mr Zelenskyy has somewhat tempered his language around NATO membership, telling Sky News in an exclusive interview in November that a ceasefire deal could be struck if Ukrainian territory he controlled falls “under the NATO umbrella” – allowing him to negotiate the return of the rest later “in a diplomatic way”.
However, Mr Trump has acknowledged Moscow’s opposition to Ukraine joining NATO, saying: “Russia has somebody right on their doorstep, and I can understand their feeling about that.”
Watch the full interview with Beth Rigby and Sir Keir Starmer on the Politics Hub with Sophy Ridge at 7pm.
An abusive boyfriend whose girlfriend blamed him for her death in a suicide note – after he subjected her to years of violence – has been jailed for six-and-a-half years for controlling and coercive behaviour and assault.
He was the first defendant in England to face trial for the unlawful killing of his partner after her suicide following domestic violence.
Shortly after Ms Dawes wrote her note on her phone, in which she described Wellings as a “monster”, the 23-year-old hairdresser left it with a friend before she took her own life on 22 July 2022.
Prosecuting, Paul Greaney KC cited the suicide note at Wellings’s trial. In it, Ms Dawes said he had “killed [her]”.
“He ruined every bit of strength I had left,” the note said. “I had dreams. I had a future at one point. That was taken away from me.”
Wellings denied the allegations against him and told jurors “I’m not a monster”.
While a jury cleared Wellings of Kiena’s manslaughter, Mr Greaney invited the court to sentence the defendant “on the basis that [the offending of which he was convicted] formed the background to and set the scene for her death”.
He said the abuse was “both regular and routine across the relationship”.
On one occasion, the court heard the defendant “held a drill to Kiena’s face, switched the drill on and threatened to drill out her teeth”.
‘Breaks my heart’
In a personal statement read out on her behalf in court, Angela Dawes, Kiena’s mother, said: “It breaks my heart that [Kiena’s] beautiful baby doesn’t have her mummy here because of that monster.”
“I truly hope that no other young lady or child has to go through what he did to my daughter and her baby,” she added.
Kiena’s grandmother, Irene Ball, said she had noticed at times during Kiena’s relationship with Wellings that her smile was “false” but recalled her granddaughter “tried to reassure [her]”.
“It was extremely shocking to see my granddaughter hurt and with injuries to her beautiful face,” she said.
“I told Kiena that he would really badly hurt her one day and I pleaded with her not to go back to him.”
Kynan Dawes, Kiena’s brother, said: “I introduced Kiena to this monster and I will regret that for the rest of my life.”
Mr Dawes said he felt “justice [had] been served” as “the world now knows what a monster he is”.
Addressing those who’d been following Kiena’s case online, he added: “I want people to see that domestic violence is not OK and men should respect their partners.”
He also urged anyone experiencing domestic violence to “go to the police”, adding “if you don’t feel like you can do this, speak to family or friends”.
‘Friendly and kind young woman’
In sentencing, Judge Robert Altham said Ms Dawes was “a popular, vivacious, friendly and kind young woman”.
“She pleaded with you to stop hitting her, but you just carried on. You tried to persuade her that it was her fault for upsetting you,” he added.
Ms Dawes had attempted suicide in the past, before her relationship with Wellings, and lawyers for Wellings told the court her death was because of “multiple factors”.
The judge said the defendant was aware of Ms Dawes’s history of mental health issues, he “called her names connected with her illness” and “repeatedly told her that she may as well kill herself”.
However, he said his sentence was based on the jury’s conclusion that the defendant had “no criminal responsibility” for Kiena’s death.
In mitigation, John Jones KC told the court the relationship between Ms Dawes and Wellings, a landscape gardener from Bispham who had a previous conviction for battering an ex-partner, was “inconsistent” throughout its two-and-a-half years.
“It would be wrong to say that that coercive relationship was in existence throughout,” he said.
The court heard the abuse of Ms Dawes included regular slapping and “ragging” by her hair, and threats to use a drill to take out her teeth and throw acid in her face.
After she became pregnant, Wellings gave her a black eye and began criticising her weight, calling her “fat” while contacting escorts and prostitutes online.
Police were called more than once, but Wellings threatened Ms Dawes that their daughter would be taken from them if she told them what was happening, so she declined to help prosecute him.
But she did report Wellings following an attack which left her needing hospital treatment and he was arrested.
He broke his bail conditions but was not locked up, leaving Ms Dawes feeling let down by police. Four days later, she killed herself.
Wellings’ sentences, to run consecutively, were for controlling or coercive behaviour in an intimate relationship and for assault occasioning actual bodily harm.
A further count of assault on the defendant’s former friend Scott Fletcher was also included as part of the sentence, an offence to which he had previously pleaded guilty.
Wellings will serve half of the sentence in prison before he is released on licence.
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
The teenager who stabbed 15-year-old Elianne Andam to death in a row over a teddy bear has been found guilty of murder.
Hassan Sentamu, 18, attacked Elianne with a kitchen knife in “white-hot anger at having been disrespected” after she stood up for his ex-girlfriend, the Old Bailey heard.
He had been due to return items including a teddy bear to Elianne’s friend following their break-up but instead came armed, wearing two pairs of gloves and a facemask.
Elianne collapsed outside the Whitgift Centre in central Croydon, south London, after being stabbed four times in what police described as a “frenzied” attack, which was caught on CCTV, on 27 September 2023.
Her friend compared Sentamu to a character from the Netflix crime drama Top Boy and said Elianne had her hand out begging him to “stop”.
He threw his gloves and mask in a bin and hid the knife in a garden but was arrested within 90 minutes after police stopped a bus near his home in New Addington.
Sentamu, who was 17 at the time, admitted manslaughter but denied murder on the basis of “loss of control” because he has autism.
There were sobs in the public as he was found guilty by a majority verdict of 10 to two, while he stood propping himself up with both arms in the dock and crying.
He was also found guilty on a charge of having a blade. Sentamu had also denied this charge – claiming he had a lawful reason for carrying it.
Grime artist Stormzy was among thousands of mourners who gathered at a candlelit vigil after Elianne – who went to the private Old Palace of John Whitgift School – was killed, and there is now a memorial to her at the scene.
‘I’ll do it again’
The month after Elianne’s death, Sentamu got into a row with a fellow inmate in youth custody and when he was accused of killing girls, said: “I’ll do it again,” the court heard.
“I’ll do it to your mum,” he said. “Do you want to end up like her, six feet under? I’ll do the same again.”
Sentamu, who came to the UK aged five with his mother and three sisters, had a history of violent and aggressive behaviour, as well as making repeated threats to take his own life.
He was given a police caution after pulling a knife out in class and telling a teacher he wanted to kill himself when he was just 12 years old.
Sentamu was expelled from one school after threatening another child with a knife and in other incidents put girls in headlocks and threatened to stab a student with a pair of scissors.
While in foster care he threatened to harm a cat or chop off its tail, the court heard.
‘I can’t let this slide’
Weeks before he killed Elianne, who wanted to become a human rights lawyer, Sentamu said: “The real me is evil, dark and miserable” in a message to a friend.
The day before the attack, he had met Elianne and her friend, who had recently split up with him, at the Whitgift Centre, where the girls “teased” him and his ex-girlfriend splashed him with water.
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Attack caught on CCTV
Sentamu, who was studying sports science at Croydon College, later sent what police called a “chilling” message to a friend saying: “I can’t let this slide bro.”
He met Elianne, his ex-girlfriend and another of their friends the following day to swap belongings.
The girl handed him a plastic bag of his clothes, but he did not have her teddy bear as arranged, and Eliane snatched the bag back.
A Snapchat video shows Elianne smiling and laughing before her expression turned to “abject terror,” jurors were told.
Sentamu pulled the kitchen knife from his trousers and repeatedly stabbed her, plunging the blade 12cm into her neck.
‘He exacted vengeance on a girl running away’
Prosecutor Alex Chalk KC earlier told jurors Sentamu was “angry… having brooded on the insult and he took the knife to the scene to reassert dominance”.
“He exacted vengeance on a young girl clearly running away from him and posing no threat,” he said.
Sentamu, who was diagnosed with autism in 2020, did not give evidence.
His barrister Pavlos Panayi KC said it was not disputed the killing was a “grotesque overreaction” but the “central issue” in the case was Sentamu’s autism history and symptoms.
Metropolitan Police Detective Chief Inspector Becky Woodsford said it was a “violent, aggressive and frenzied knife attack on a young girl”.
“Elianne was doing what was right, she was standing up for her friend,” she added.