Of course, we’d all prefer to avoid surgery. That’s why orthopaedic surgeon DR ALAN CHEUNG always offers a non-surgical approach to his patients as the first line of treatment for injuries like an ACL tear, and osteoarthritis. But, in some cases, medication and a referral to a physiotherapist just won’t cut it. Here, he shares three scenarios where orthopaedic surgery may be the best solution.
#1 Complete ACL tear
The anterior cruciate ligament (ACL) is one of the four main ligaments that stabilise the knee. It is commonly torn during activities that involve tackling, jumping, stopping suddenly or quickly changing direction. Typical symptoms of an ACL tear include immediate pain, knee instability and swelling.
When torn completely, the ACL does not tend to heal well, explains Dr Cheung. One solution is to surgically replace the torn ligament with a tissue graft – usually made up of hamstring tendons. This procedure is generally straightforward, with patients usually going home the same day. However, recovery time is long. In fact, it can take nine to 12 months of physiotherapy to get a patient back to playing sports after surgery for an ACL tear.
Dr Cheung says it’s worth seeing a good physiotherapist on the recommendation of your orthopaedic surgeon, and undergoing rehab before considering ACL surgery.
“This allows your knee to regain full range of movement and strength, and allows the bone bruising to settle. Some doctors also argue that ACL reconstruction is associated with a lower risk of early arthritis.”
#2 Large meniscal tear
While this type of injury most commonly occurs during contact sports, all it takes is a sudden twist, or getting up from a squat the wrong way, to create enough force to tear the meniscus – the rubbery shock absorber that provides cushioning between your thighbone and shinbone. The result is pain, tenderness and a locking sensation.
Sometimes, a small tear can be left alone. However, a larger tear can prevent the knee from being straightened. This “locking of the knee” will need to be surgically repaired or replaced by an orthopaedic surgeon.
Luckily, he says that both methods he performs for meniscal tears are minimally invasive keyhole surgeries that have good results. A patient may be back to sports within six to eight weeks or three to four months, depending on the type of procedure performed.
#3 Osteoarthritis of the knee and hip joints
For patients with worn-out hip and knee joints, Dr Cheung usually recommends physiotherapy, painkillers and a steroid injection to relieve the pain. However, if the pain is severe and the joint is too worn out, there may be no choice but to replace it.
In this case, robotic joint replacement is an extremely effective way of reducing pain and restoring quality of life. It involves the use of a robotic arm to assist with surgery, and helps reduce the risk of damage to nerves, blood vessels and ligaments.
Dr Cheung says one major advantage of this method is that it allows the orthopaedic surgeon to plan the operation in minute detail. “Using a robot can make the process more exact, reproducible and reliable. In some cases, patients can even go home on the day of surgery.”
Of course, avoiding injury in the first place is key to preventing osteoarthritis. Dr Cheung suggests undergoing an injury prevention programme, strength training and physiotherapy to reduce knee injuries.
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