East Yorkshire Sports Medicine Services – Edwards Orthopaedics
A new clinic and service based at Flex Health facilities in Hull providing a comprehensive sports medicine service for the elite and everyday athlete. I work closely with the Flex Health therapists and have close contacts with surgeons, specialist physiotherapists, strength and conditioners and sports therapists who have extensive experience in elite sport. If the client requires physiotherapy, strength and conditioning, sports massage, or, if necessary, surgical intervention then this can be arranged expediently locally or if necessary, further afield.
Acute swelling of the knee as a result of an injury can signify a significant internal structural derangement. This may include cartilage (meniscus) tear, lining cartilage (articular) injury or ligament injury. Often an urgent arthroscopy is required to washout the fluid from the knee and to assess and where possible repair the damage.
When a knee cartilage is torn near its outer margin with the knee capsule, it is sometimes possible to repair it. Since the blood supply to the meniscus cartilage is only present in its outer margin, most tears are not amenable to repair but rather need excision of the torn portion. When a reasonable chance of healing is present Mr Edwards will utilise a mixture of the all inside technique and the inside-out technique to suture the meniscus together with or without an additional injection of blood directly into the repair.
A full thickness cartilage injury with underlying bone is called an osteochondral fracture. The fragment can remain in place or be displaced into the joint. Occasionally it can be repaired, but more often the fragment needs to be removed. The defect may fill by itself, but when it does not, cartilage grafting may be required. Mr Edwards has used the semi-synthetic graft from Finceramica (MaioRegen®) to treat these cartilage defects. Some cartilage defects develop over time rather than acute injury. These are treated by chondroplasty – removing the fragmented and fibrillated cartilage and smoothing the uneven surface either with an abrasion or a radiofrequency ablation technique. Microfracture is the next line of treatment where after abrasion of the defect, a number of 1mm holes are made into the prepared surface inorder for new cells from the bone to attempt to fill the defect with cartilage. If these techniques are not successful the MaioRegen® graft may be appropriate.
Having a knee ligament injury in an active or sports person can have very significant consequences to that person’s ability to continue to participate in their chosen activity. Damage to the ACL is the most common injury that requires surgery. Medial ligament (MCL) injuries most often can be treated in a brace without the need for surgery. Lateral ligament injuries are usually more complex and often require repair or reconstruction. Posterior cruciate ligament injuries are relatively uncommon and often do not prevent the injured person from recovering to a similar pre-injury level without surgery. Occasionally this is not the case, especially if other ligaments are involved.
When cruciate ligament injury results in knee instability there is the potential for further knee trauma if the person continues to participate in the same physical activities. Mr Edwards uses a variety of graft reconstruction techniques geared to the individual’s knee and physical demands. Autograft hamstring tendon is Mr. Edwards’ most common choice of graft, but he also uses the bone – patella tendon – bone graft and in certain circumstances, donor graft tissue as necessary.
Ligament reconstruction may require urgent attention in the case of lateral ligament complex injuries, but for other ligament reconstruction a planned operation when the acute injury phase is over is more appropriate.
If you suffer from anterior knee pain it can make a significant impact on your ability to exercise. In most cases there is overload of the patello-femoral joint that with the correct exercise regimen can be overcome. Occasionally a knee brace or taping is required. Injections of PRP for patella tendinopathies may be necessary and surgery can be contemplated if required. Arthroscopic treatments for maltracking and cartilage injuries many be necessary in some patients.
Acute disclocation of the patella is very painful and traumatic to the patient. It can be accompanied by significant damage to the ligament that acts to stabilise the patella on the medial side (MPFL) and chondral (or osteochondral) injuries. Treatment often requires MPFL repair or reconstruction using a graft as well as treatment to the chondral surface of the patella or femur. Mr. Edwards may elect to undertake an MPFL advancement along with release of the lateral retinaculum or in some cases a tendon graft augmentation of the MPFL.
Cartilage treatments can include debridement, microfracture, direct repair or grafting.
Pain related to inflammation of tendons frequently affect sports people as well as less active people. If physiotherapy and functional modifications fail to relieve the pain, Mr Edwards may consider the use of platelet-rich plasma (PRP) injection. This is an injection of the patient’s own blood which has been separated by centrifuge in order to siphon off the platelet portion. These cells contain numerous chemical factors that promote a healing response. The evidence for its efficacy is still patchy and NICE guidance recommends patients are followed closely for audit and governance purposes.
Groin pain in sports people can be a difficult condition to firstly diagnose and then to treat appropriately. Groin pain can be due to hernias, tendinopathies or hip joint problems along with osetiitis pubis, snapping rectus femoris tendon and a number of other conditions. Getting the diagnosis correct is key of course. If the condition is within the hip this may be amenable to hip arthroscopic treatments.
Having an ankle sprain is very common. Sometimes however there is a complete rupture or recurrent instability of the ankle ligaments. This can be accompanied by ankle internal derangement. Mr Edwards may arthroscope your ankle and then proceed to repair the lateral ligament that is most commonly injured. If a sports person has an acute syndesmotic injury, Mr Edwards usually refers on to a colleague in York for further assessment and treatment.
Hip arthroscopy has been undertaken for many years, but its efficacy has only recently been proven. “Femero-acetabular impingement” (FAI) as a source of hip pain and labral injury has been recently recognised in the world literature, and its treatment arthroscopically has yielded good results. Conditions treated arthroscopically by Mr Edwards include FAI, labral tear (repair or debridement), synovitis and loose bodies within the hip. In addition, isolated chondral lesions on the femoral or acetabular articular surfaces can also be treated arthroscopically with debridement, ablation or microfracture, and refractory trochanteric pain syndromes that have failed conservative measures may be treated arthroscopically.
Sports people can suffer from tears to the labrum of the hip joint. This tissue is similar to the meniscus cartilage of the knee and can be acutely torn or suffer from degenerative tears. Arthroscopic treatment would aim to repair the torn labrum or debride the unstable portion. Other acute injuries that may be amenable to hip arthroscopy include chondral defects (lining cartilage), ligamentum flavum tears and hip impingement.
Ankle impingement can cause significant ongoing pain on activity. Where appropriate, Mr Edwards may undertake arthroscopic debridement of impinging tissues including the synovium or anterior bone. If cartilage injury is present to the tibia or the talus, this can be treated by debridement, microfracture or semi-synthetic cartilage graft placement.
When the ATFL is significantly injured and dysfunctional, the person’s ankle can be unstable resulting in repeated sprain injuries. A repair of the ligament structure may be required where the ankle is arthroscoped first to remove any synovitis in the lateral gutter before an incision is made over the region of the ligament in order to directly repair it using the Brostrum technique with augmentation using the “Internal Brace” ® from Arthrex.