How sports surgery landscape is evolving in handling soft tissue injuries

Soft tissue injuries are the bane of any physically active individual. Be it a professional athlete or an amateur, they are the most common injuries and high-grade injuries generally don’t self-heal and lead to additional injuries and subsequent joint damage if not surgically treated.

While preventing these afflictions is not always possible, what matters most is getting back into action quickly and at the same level that is very crucial for the active individual including athletes.

One of the most frequent knee injuries suffered by athletes and exercise enthusiasts is anterior cruciate ligament injury commonly known as an ACL tear. A high-grade ACL tear requires key-hole surgery (Arthroscopic ACL Reconstruction) to allow the return to sports activity and importantly prevent further joint damage. Technically, this surgery has evolved over the years to improve functional outcomes. One recent innovation involves ACL graft augmentation with a high-strength suture (Internal brace). Recent scientific evidence has shown this technique to be safe with the advantage of reducing the risk of ACL graft re-tear, thereby improving functional outcomes.

In our experience, in over 250 patients treated with this technique superior knee stability and better outcomes were observed. To further improve the patient-care, multi-disciplinary hospitals with full-time specialists should be considered as they ensure easy availability and access to round-clock care resulting in faster recovery.

Another common Sports related injury in the knee is damage to the Joint Cartilage. This again, if left untreated can lead to symptomatic arthritis. Usually, when a cartilage breaks, a void is left, where the natural mending process is poor. Hence, cartilage repair or regeneration surgery to restore the damaged cartilage is indicated. The goal of the surgical procedure is to regenerate native type cartilage for superior functional outcomes.

Until recently, in most cases, this was a two-stage procedure involving a laboratory phase adding additional time, cost, and two hospital admissions, thereby prolonging recovery time. A recent innovation to overcome these issues is a one-stage arthroscopic procedure which is routinely performed by us. In this technique, the patient’s cartilage from the damaged area which was earlier discarded is collected and revived to health using the patient‘s own blood component Platelet-Rich Plasma (PRP) and reapplied during the same procedure to the void from the injury. The results of this latest technique have been encouraging.

Injury to the Shoulder ligament (Labrum) is also a commonly seen injury due to sports, fall or accident. Whilst patients with low grade injury recover with physiotherapy, those with high grade tear experience recurring shoulder instability with weakness in activities and require Arthroscopic ligament repair surgery as the ligament tear does not self-heal. This surgery too has evolved in technique and fixation to improve functional outcomes. The newer techniques we routinely perform include ligament repair/ bone augmentation where necessary using low profile knotless sutures instead of conventional metallic implants with good resultant outcomes.

The aim is to create awareness of these recent techniques used in sports surgery, thereby enabling more people to benefit from these advances in technology for managing sports injuries.

The author is Consultant & Unit Head, Sports Orthopaedics, Arthroscopy & Trauma, Kokilaben Dhirubhai Ambani Hospital, Mumbai. Views are personal.

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