Sports Injuries: New Techniques in Ankle and Knee Surgery
PROFESSIONAL CARE OF MOTHER AND CHILD, 2000
Dear Editor, I was interested to read the article "Sports Injuries in Young Athletes Part 1" by Dr Kate Kerr (Professional Care of Mother & Child 1999; 9[3]: 68-77). As she makes clear, certain injuries can have "serious and permanent consequences". The ankle has always been a notoriously vulnerable area for young people and many who sustain an ankle injury do not fully recover. One of the reasons for this is that the size of their joints makes it difficult to see inside, or to find instruments small enough with which to operate.
However, the new advances in keyhole surgery, or arthroscopy, that so transformed knee and shoulder treatment, have now been adapted for ankle injuries, and now even major ankle injuries need not necessarily mean one's premature end as an athlete.
Until about five years ago, the X-ray and the MRI scan were the standard way to get a closer look at the ankle. But an X-ray cannot show up soft tissue injuries and the magnetic scan is only 70-80% accurate and tends to involve a few days of waiting.
Modern technology has now created smaller instruments to which a camera can be attached. This camera can be inserted right inside the joint, which enables surgeons to gain a 100% accurate diagnosis.
Moreover, if surgery is required, arthroscopy can be dramatically quicker and more effective. In the past, ankle surgery usually meant a two to three day stay in hospital. In order to access the joint, the
surgeon had to make a fairly large incision. The patients left hospital, on crutches, often in plaster and with a sizeable scar and a long recuperation period ahead of them. Young athletes could find themselves off the playing field for up to three months.
Arthroscopic surgery can usually be carried out as a day-case procedure and involves the placement of two or three tiny holes around the ankle. Patients typically experience very little postoperative pain and can usually walk out of hospital with no difficulty.
Even so, however good today's technology has become. it should not be used as a substitue for preventive measures. As Dr Kerr points out, many sports injuries in young people are overuse injuries, which can be avoided. For those of all ages who are involved in regular sport, good footwear and regular stretch programmes are essential.
But excessive training could aggravate a problem. Pain in the ankle or Achilles' tendon is generallly the body's way of telling us that something is wrong. If the pain fails to ease after resting, it is vital to seek medical attention. With the swift diagnosis and treatment now available, this needn't be such a daunting prospect.
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