Knee and shoulder injuries are by far the most common problems seen at many sports clinics. This is a reflection of the more popular sports Singaporeans indulge in. Common shoulder injuries seen are recurrent shoulder dislocation, impingement syndrome, rotator cuff tears and acromioclavicular injuries. Meniscus and ligament tears as well as cartilage injuries are common knee problems seen.

Serious injuries can result from neglect of persistent and recurring problems which in many instances can end your sporting career prematurely. However, results of treatment of theses soft tissue injuries had made a quantum leap in recent years because of better understanding of science and the biology of healing. Recent advances in bioengineering had helped by developing biomaterials, tissues, grafts and instrumentations which made surgery more precise and healing more definate. From injuries of ligaments to cartilage and of any joint in the body, a solution can be found. Many of these procedures can be done through the key-hole or arthroscopic approach.

Most of the new advances in knee injury treatment relate to better treatment of the meniscus, cruciate ligaments tears and cartilage defects. The repair of meniscus can be done in double quick time with new suturing techniques. Meniscus defects can be transplanted with artificial meniscus or with cadaveric substitutes. Cartilage defects can now be covered with mosaicplasty or cartilage transplantation. New treatment for cruciate ligament injuries with double tunnel techniques improves the mechanical function of the new graft.

Most knee ligament injuries are a result of sprains and will heal with rest, anti-inflammatory medication and physiotherapy. If surgery is required, the anterior cruciate is by far the most commonly reconstructed ligament of the knee. The posterior cruciate ligament is far less common but the approach to its reconstruction is similar to the anterior cruciate ligament.

Shoulder Injuries Treated With Key-Hole Surgery

The shoulder joint is designed to give a large amount of movement to enable us to swing and throw with relative ease and with great force. It is often described as a golf ball on a tee peg and is a ball and socket joint, with the ball much larger than the socket. This results in greater mobility but the price to pay for greater flexibility is reduced stability. Therefore support from the ligaments and muscles is essential. Connecting the shoulder girdle to the trunk is the acromioclavicular joint, which is a relatively rigid joint. Around the shoulder joint lies a group of muscles known as the rotator cuff which moves the shoulder up against gravity.

The common shoulder problems treated arthroscopically are:

1. Acromioclavicular arthritis.

2. Subacromial impingement

3. Shoulder Instability

4. Rotator-cuff tear

Arthroscopic Shoulder Surgery

Arthroscopy has revolutionized the treatment of these shoulder problems. Most primary procedures are suitable for keyhole surgery and the shoulder joint is one of the commonest joints where arthroscopic procedures are performed. Advantages of the arthroscopic method include less tissue damage, less blood loss, less post-surgery pain, being done as day case surgery with shorter period of time off work, better cosmesis and less stiffness.

Shoulder Keyhole procedure

Conclusion

With the development of better implants and techniques, arthroscopic surgery has revolutionized the management of shoulder and knee injuries. Results of treatment are similar and in certain instances, superior to open procedures, enabling the patient to return to normal function early. Many professional sportsmen and women are able to resume training within one to two weeks of an arthroscopic procedure. Good post surgery physiotherapy is essential and gradual return to training is important to protect any reconstruction until it heals.

Contributed by Dr THO Kam San

Consultant Orthopaedic & Sports Surgeon

ISLAND Orthopaedic Consultants

#01-04 Mt Alvernia Medical Centre

820 Thomson Road Singapore 574623

Tel: 63560588

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