Sports Medicine

Areas we specialise in Sports Medicine

Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of the bursa. There are two major bursae in the hip that typically become irritated and inflamed. One bursa covers the bony point of the hip bone called the greater trochanter. Inflammation of this bursa is called trochanteric bursitis.

Another bursa — the iliopsoas bursa — is located on the inside (groin side) of the hip. When this bursa becomes inflamed, the condition is also sometimes referred to as hip bursitis, but the pain is located in the groin area. This condition is not as common as trochanteric bursitis, but is treated in a similar manner.

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incision and low complication rates.

Description

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered "sprains" and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

Cause

The anterior cruciate ligament can be injured in several ways:

• Changing direction rapidly

• Stopping suddenly

• Slowing down while running

• Landing from a jump incorrectly

• Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

Symptoms

When you injure your ACL, you might hear a loud "pop" sound and you may feel the knee buckle.  Other typical symptoms include:

• Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.

• Loss of full range of motion

• Tenderness along the joint line

• Discomfort while walking

Treatment for Surgery

Rebuilding the ligament. Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on.

Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used.

There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you.

Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.

Procedure

Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive. The benefits of less invasive techniques include less pain from surgery, less time spent in the hospital, and quicker recovery times.

Rehabilitation

Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.

If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete's sport.

Did you recently hear or feel a “pop” in your knee? Even if you can still walk with the pain, it’s quite likely that you could have experienced a meniscal tear. This injury is common among athletes and can also occur in people with arthritis.

Anatomy

You have two C-shaped discs of cartilage (soft tissue) that connect your thigh bone to your shinbone. These are called menisci. They’re like shock absorbers for your bones. They also help to keep your knee stable.

Description

Athletes who play contact sports like football and hockey are prone to meniscus tears. But you can also get this injury when you kneel, squat, or lift something heavy. The risk of injury increases as you get older, when bones and tissues around the knee begin to wear down.If you tear your meniscus, your leg might swell and feel stiff. You might feel pain when twisting your knee, or be unable to straighten your leg fully.

Some people never experience symptoms, but many do. When a person hears or feels that distinctive POP, there are a number of symptoms that could follow:

• Pain, swelling, and stiffness

• Popping sound while moving

• Weakness that leads to the knee giving way

• Knee locking into place (requires surgery to repair)

Treatment

Your Orthopaedic Surgeon’s recommendation for treatment will depend on the size and placement of the tear, one’s age, health and medical history, activity level, and when the injury took place.

Arthroscopic meniscus repair is an outpatient surgical procedure to repair torn knee cartilage. The torn meniscus is repaired by a variety of minimally invasive techniques and requires postoperative protection to allow healing.

If you’ve lost functionality in your knee and are unable to do the everyday things you love, these are the biggest indicators that surgery is right for you. However, surgery may be an immediate requirement in severe cases.

Procedure

Meniscus repair surgery is a procedure used to repair either the medial or lateral menisci. During this minimally invasive arthroscopic surgery, your doctor gains access to the knee through small incisions. By inserting an arthroscope, a medical device with a light and camera, your doctor can view the damage and determine how best to proceed. 

Rehabilatation

In most cases, patients are discharged the very same day of surgery. Your knee will be wrapped it in a bandage, and you can expect a small amount of drainage from the surgery site. You will also be given instructions on how to care for your knee. For example, you will need to elevate your knee while you are lying in bed. Recovery takes two to six weeks to complete. During this time, you will be using crutches and attending physical therapy sessions to ensure a speedy recovery process. Eventually, you will wean off crutches and return to your normal activities. You will be able to enjoy hobbies and activities free from the pain of a torn meniscus. If you believe you’ve torn your meniscus and aren’t ready to say goodbye to an active lifestyle, schedule a consultation for meniscus repair surgery today.

The meniscus is a C-shaped cushion of cartilage in the knee joint. When people talk about "torn cartilage" in the knee, they are usually referring to a torn meniscus.

Description

If your meniscus is severely damaged or has been removed,  the articular cartilage protecting your knee may begin to wear, similar to how rubber on a car tire wears away over time. As this cartilage wears away, it can lead to pain and disability. This condition is called osteoarthritis.

The goal of meniscal transplant surgery is to replace the meniscus cushion before the articular cartilage is damaged. The donor meniscus is intended to take the place of the native meniscus, relieve knee pain, and prevent the progression to osteoarthritis.

Allograft Preparation

Healthy cartilage tissue is taken from a cadaver (human donor) and frozen. This tissue is called an allograft. It is sized, tested for disease, and stored. Correct sizing is one of the most important factors in the success of the transplant. Later, the allograft will be matched by size to a candidate for the procedure.

Allograft Safety

A screening process is done before selecting a possible donor. Someone who knows the donor well is interviewed to help identify risk factors that would prevent the use of the donor tissue.

Once selected, the donor tissue undergoes many tests. The safety of the tissue is monitored by the American Association of Tissue Banks and the United States Food and Drug Administration. The tissue is tested for viruses like those that cause HIV/AIDS, West Nile virus, hepatitis B and C, as well as for bacteria.

A meniscal transplant is not like a heart or lung transplant, in which “rejection” can occur. Additionally, patients do not need to be on immunosuppressants or other medications after the procedure.

Candidates for Surgery

Although meniscal transplants have been performed for more than 20 years, the procedure is still relatively uncommon. This is largely due to the strict criteria patients must meet to be considered for the procedure.

Most people with severe meniscal problems have also developed arthritis in the knee. If the articular cartilage has worn away too much, a meniscal transplant will not be helpful.

The criteria for meniscal transplant include:

• Younger than 40-45 years and physically active

• Missing a significant portion of the meniscus as the result of previous surgery or injury

• Persistent activity-related pain

• Knee with stable ligaments and normal alignment (alignment issues can also be corrected at the time of the transplant with a procedure called an “osteotomy”)

• No or minimal knee osteoarthritis and no rheumatoid arthritis

• Not obese

Surgery

Meniscal transplant surgery is an arthroscopic procedure that usually needs one or two small incisions. It is typically performed on an outpatient basis.

A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disk that acts as a "shock absorber" between the thighbone and shinbone. It helps cushion and stabilise the knee joint. Each knee has two menisci—one on the outside of the knee and one on the inside.

Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy cartilage in our joints makes it easier to move. It allows the bones to glide over each other with very little friction.

Knee arthroscopy is a surgical procedure that allows doctors to view the knee joint without making a large incision (cut) through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide range of knee problems.

During knee arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your knee joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain and joint stiffness for patients, and often shortens the time it takes to recover and return to favorite activities.

When Knee Arthroscopy is Recommended

Dr Konidaris may recommend knee arthroscopy if you have a painful condition that does not respond to nonsurgical treatment.

Knee arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint.

Common arthroscopic procedures for the knee include:

• Partial meniscectomy (removal of the meniscus), repair of a torn meniscus, or meniscus transplantation

• Reconstruction of a torn anterior cruciate ligament or posterior cruciate ligament

• Removal of inflamed synovial tissue

• Trimming or reconstruction of damaged articular cartilage

• Removal of loose fragments of bone or cartilage, like those caused by synovial chondromatosis

• Treatment of patella (kneecap) problems

• Treatment of knee sepsis (infection)

Surgical Procedures

Positioning

Once you are moved into the operating room, you will be given anesthesia. To help prevent surgical site infection, the skin on your knee will be cleaned. Your leg will be covered with surgical draping that exposes the prepared incision site.

At this point, a positioning device is sometimes placed on the leg to help stabilise the knee while the arthroscopic procedure takes place.

Procedure

To begin the procedure, your surgeon will make a few small incisions, called portals, in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see the structures inside your knee clearly and in great detail.

The first task is for your surgeon to properly diagnose your problem. They will insert the arthroscope and use the image projected on the screen to guide it. If surgical treatment is needed, your surgeon will insert tiny instruments through other small incisions.

Specialised instruments are used for tasks like shaving, cutting, grasping, and meniscal repair. In many cases, special devices are used to anchor stitches into bone.

Click on the video below to watch an arthroscopic treatment for a bucket handle tear.

This video © American Academy of Orthopaedic Surgeons.

As with other arthritic conditions, initial treatment of arthritis of the knee is nonsurgical. Your doctor may recommend a range of treatment options.

Lifestyle modifications

 Some changes in your daily life can protect your knee joint and slow the progress of arthritis.

• Minimise activities that aggravate the condition, such as climbing stairs.

• Switching from high-impact activities (like jogging or tennis) to lower impact activities (like swimming or cycling) will put less stress on your knee.

• Losing weight can reduce stress on the knee joint, resulting in less pain and increased function.

Physical therapy

Specific exercises can help increase range of motion and flexibility, as well as help strengthen the muscles in your leg. Your doctor or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Assistive devices

Using devices such as a cane, wearing shock-absorbing shoes or inserts, or wearing a brace or knee sleeve can be helpful. A brace assists with stability and function, and may be especially helpful if the arthritis is centered on one side of the knee. There are two types of braces that are often used for knee arthritis: An "unloader" brace shifts weight away from the affected portion of the knee, while a "support" brace helps support the entire knee load.

Other remedies

Applying heat or ice, using pain-relieving ointments or creams, or wearing elastic bandages to provide support to the knee may provide some relief from pain.

Medications

Several types of drugs are useful in treating arthritis of the knee. Because people respond differently to medications, your doctor will work closely with you to determine the medications and dosages that are safe and effective for you.

• Over-the-counter, non-narcotic pain relievers and anti-inflammatory medications are usually the first choice of therapy for arthritis of the knee. Paracetamol is a simple, over-the-counter pain reliever that can be effective in reducing arthritis pain.
  
  Like all medications, over-the-counter pain relievers can cause side effects and interact with other medications you are taking. Be sure to discuss potential side effects with your doctor.
  

• Another type of pain reliever is a nonsteroidal anti-inflammatory drug, or NSAID (pronounced "en-said"). NSAIDs, such as ibuprofen and naproxen, are available both over-the-counter and by prescription.
  

• A COX-2 inhibitor is a special type of NSAID that may cause fewer gastrointestinal side effects. Common brand names of COX-2 inhibitors include Celebrex (celecoxib) and Mobic (meloxicam, which is a partial COX-2 inhibitor). A COX-2 inhibitor reduces pain and inflammation so that you can function better. If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot, hypertension, or if you are sensitive to aspirin, sulfa drugs, or other NSAIDs.
  

• Corticosteroids (also known as cortisone) are powerful anti-inflammatory agents that can be injected into the joint. These injections provide pain relief and reduce inflammation; however, the effects do not last indefinitely. Your doctor may recommend limiting the number of injections to three or four per year, per joint, due to possible side effects.
  
  In some cases, pain and swelling may "flare" immediately after the injection, and the potential exists for long-term joint damage or infection. With frequent repeated injections, or injections over an extended period of time, joint damage can actually increase rather than decrease.
  

• Disease-modifying anti-rheumatic drugs (DMARDs) are used to slow the progression of rheumatoid arthritis. Drugs like methotrexate, sulfasalazine, and hydroxychloroquine are commonly prescribed.
  
  In addition, biologic DMARDs like etanercept (Enbrel) and adalimumab (Humira) may reduce the body's overactive immune response. Because there are many different drugs today for rheumatoid arthritis, a rheumatology specialist is often required to effectively manage medications.
  

• Viscosupplementation involves injecting substances into the joint to improve the quality of the joint fluid.
  
  

Alternative therapies

Many alternative forms of therapy are unproven, but may be helpful to try, provided you find a qualified practitioner and keep your doctor informed of your decision. Alternative therapies to treat pain include the use of acupuncture, magnetic pulse therapy, platelet-rich plasma, and stem cell injections.

Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. Although it is used in many parts of the world and evidence suggests that it can help ease the pain of arthritis, there are few scientific studies of its effectiveness. Be sure your acupuncturist is certified, and do not hesitate to ask about his or her sterilisation practices.

Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Like many alternative therapies, magnetic pulse therapy has yet to be proven.

Treatments such as platelet-rich plasma (PRP) and stem cell injections involve taking cells from your own body and re-injecting them into a painful joint.

PRP uses a component of your own blood, platelets, that have been separated from your blood, concentrated, and injected into your knee. The platelets contain “growth factors” thought to be helpful in reducing the symptoms of inflammation. 

Stem cells are precursor cells that can also be taken from your own body and injected into your knee. Since they are basic cells, they may have potential to grow into new tissue and thus heal damaged joint surfaces.

While both treatments show promise, clinical studies have yet to confirm their value in treating osteoarthritis.