For full details about Island Orthopaedic Group, please see website
Doctors articles on various injuries
Anterior Cruciate Ligament Reconstruction
Tips for Preventing Injury in Runners
Anterior Cruciate Ligament Reconstruction
By Dr THO Kam San
Specialist Orthopaedic Surgeon
MBBS (Singpore) M.MED (Surg) FRCS (Edinburgh) FAMS (Orth)
Sports Surgery, Arthroscopic Reconstruction, Knee & Hip Surgery
In the pursuit of sporting activities, it is not uncommon for many to sprain their knees. Most of these sprains are minor and they recover fully after a short period of rest. If the knee is still swollen, painful and limited in its ability to bend after a few days or feels wobbly and unstable, it is likely that the knee has sustained significant injuries which should be attended to. Soccer and basketball players constitute the majority of patients who sustain serious damage their knee. This is not surprising in view of the immense popularity of these sports as well as the robust nature of the sport and the strain the knee is subjected to. Most commonly, the anterior cruciate ligament is torn as a result. The incidence of anterior cruciate ligament tear varies with age and sex; younger athletes more often than older athletes and men more than women. If you ask the afflicted, they may tell of a 'pop' sound during the injury with the knee buckling and giving way. There is usually swelling of the knee within the first few hours.
This injury can be debilitating because the anterior cruciate ligament of the knee is an important stabiliser of the knee, especially during pivoting manoeuvres like turning on the run, jumping, accelerating and decelerating. The main problem of patients with anterior cruciate ligament deficiency is the unpleasant sensation of the knee giving way, causing much inconveniences in the simplest of everyday tasks. Some of these patients regain sufficient control of their knees after physical therapy to manage at a reasonable level of activity.
However, a significant proportion of these ACL-deficient knees give way often enough and at the slightest provocation that the patient often feels incapacitated, unable to enjoy doing the things the used to and want to do. Apart from the physical incapacity, the frequent giving way of the knees may damage the meniscus and joint surface which will result in degenerative changes in the joint. These are reasons to advice these patients to reconstruct the torn ACL and stabilise the knee.
ACL reconstruction is one of the most common operations performed by the orthopaedic surgeon. Restoration of knee stability and return to activity can generally be expected in the majority of patients after such a procedure. The patellar tendon graft has been considered the ideal graft choice. It has good structural and fixation properties, a potential for bone-to-bone healing, and a predictable success rate in the restoration of knee stability. However, donor-site problems have been reported after harvest of patellar tendon grafts. Anterior knee pain, loss of sensation, patellar fracture and loss of extension strength impair knee function in spite of a successful replacement of the ACL. Therefore, use of the hamstring tendon graft has increased in popularity as its use incurs fewer donor-site complications. The structural strength of a hamstring tendon graft is superior to that of a 10-mm patellar tendon-bone graft. The trend toward increased popularity of the hamstring tendon graft is also related to the development of fixation techniques better than those previously used compared with those used for fixation of the patellar tendon graft. Allografts and artificial ligaments have been used as graft substitutes but the durability of these grafts have been a problem.
Newer techniques using a double tunnel fixation has been advocated and it is make an improvement in the outcome when there is associated rotational instability of the knee. However graft failure and post surgery stiffness in double tunnel techniques can be a problem. Many surgeons are still using the conventional single bundle techniques because of its good track record over the years.
Good post-operative care and an aggressive and accelerated physiotherapy program is essential to ensure the patient has a stable and pain-free knee which will enable him to return to the activity he enjoys. Generally, it takes about 6 months of intensive rehabilitation after surgery to get the patient back to competitive sports. It is essential to get full range of movement of the knee joint as well as good quadriceps and hamstrings strength before engaging in strenuous sporting activity.
Tips for Preventing Injury in Runners
Dr. Patrick Goh
SportsMed Central Gleneagles Hospital
Specialist Sports Physician
MBBS MSS (Sports Medicine)
The repetitive nature of running can result in overuse injuries. While each runner is unique, with different injury risk factors. the following 5 points would go a long way towards reducing chance of injury in most runners:
Get the correct pair of shoes to suit your foot type, and not based on looks or price. Running shoes are typically classified as 'motion control', 'stability' or 'cushioned' for people with flat feet, mild flat/normal feet, and high arched feet respectively. Get a proper assessment if you are not sure which category your feet belong to.
Strengthen your buttock muscles. Often neglected by runners, poor hip control is actually a common cause of painful knees in runners, especially females. A simple screening test is to stand in front of a mirror while doing a single-legged half squat. If you find that your knee has a natural tendency to swing inwards on the way down, you are probably doing this while running as well. You would need to strengthen your hip abductors.
Don't overdo hills. Some runners diligently run up stairs or tackle hills in a deliberate attempt to develop power. While hill running is useful, it is not something which should be done with every run. Doing hills puts more stress on your knees and buttock muscles which often leads to muscle tightness and injury. Downhill running is probably even more damaging than the uphill running, therefore if it is mainly uphill running you want to incorporate, consider using a treadmill, where you can run uphill without having to run downhill later. In general, keep hillwork to no more than 1 - 2 times a week to keep injuries at bay.
Step up training by increasing one thing at a time. Don't increase both speed and distance at the same time. Pick only one to increase with each run you do.
Cross-train. This gives your body a break. Pool based exercise (eg. Pool running or aerobics) or other non-impact activity once a week can make a big difference.
