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Sports Service

Whether recreational or competitive, athletes are constantly at risk of sustaining sports injuries. At the Department of Orthopaedic Surgery in Singapore General Hospital, our Sports Medicine Service provides athlete-specific diagnosis that is customised to each individual case. Our primary purpose is to help our patients return to their favorite sports activities in the shortest timeframe possible, with the highest level of performance. 
Here in Singapore General Hospital, we have a team of dedicated surgeons who are passionate about treating athletic injuries concerning the musculoskeletal system. Directed by A/Prof Paul Chang, he is supported by his team of colleagues with a focus on these clinical services:

Knee

Anterior Cruciate Ligament (ACL) reconstruction
Knee replacement surgery (treatment for knee pain)
Meniscus transplantation
Cartilage chondroplasty and microfracture

Shoulder

Rotator cuff repair
Shoulder labral tear repair (anterior, superior, posterior)

Ligament

Extracorporeal Shock Wave (ESW) therapy
Platelet Rich Plasma (PRP) therapy

Type of surgical techniques:

Arthroscopy
Arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision (portal). This provides a clear view of the inside. The surgeon inserts miniature surgical instruments through other portals to trim or repair the tear and injury.

Autologous Chondrocyte Implantation
ACI is a procedure used to treat isolated full-thickness (down to bone) articular cartilage defects of the knee. It has been approved by the Food and Drug Administration for cartilage defects located at the end of the femur bone (thigh). ACI has also been performed for defects of the patella (knee cap) in addition to other joints of the body. Autologous chondrocyte implantation is a two-stage operative procedure.
The first procedure is performed arthroscopically where a small portion of the articular cartilage will be harvested. The cartilage biopsy will then be enzymatically treated in order to isolate the chondrocytes and increase its numbers for implantation. The second-stage operation is an open procedure whereby a small patch is sewn over the articular cartilage defect. Harvested chondrocytes will be injected underneath this patch. Following implantation there is a period of restricted weight-bearing for up to 8 weeks.

Clinical Services

Knee

1. Anterior Cruciate Ligament (ACL)
The ACL is one of the four main ligaments within the knee that connects the femur and tibia, responsible for stabilizing rotational movements that occur mainly during sports activities. 

Tearing of the ACL (Anterior Cruciate Ligament) occurs with a sudden direction change or when a decelerating force crosses the knee. The patient often feels or hears a popping sensation, has a rapid onset of knee swelling, and develops a buckling sensation in the knee when attempting a direction change. The tear may either be partial or complete.  

Surgical treatments:

  • Single-bundle
    A single-bundle ACL reconstruction uses a tendon graft to replace the torn ACL. Unfortunately, ACL tears cannot be repaired, or sewn together, and a graft must be used to reconstruct the ligament. When the ACL is reconstructed, the graft is placed in the position of the anteromedial bundle. Grafts are held in place by making a hole in the bone called a tunnel. One tunnel is made in the femur and one in the tibia. The graft is held in the bone with a fixation device, often a screw.
  • Double-bundle
    Instead of placing just one larger graft, the double-bundle ACL reconstruction procedure uses two smaller grafts. Therefore, there are essentially two ligament reconstructions, one for each bundle. The double-bundle procedure requires two additional bone tunnels to accommodate a second graft and one additional incision.
  • Allograft reconstruction
    Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament is removed from the knee before the graft is inserted in an 
2. Knee Replacement Surgery
Knee replacement is an operation that involves replacing a worn and damaged knee with artificial joints made of plastic, ceramic and metal parts. The focus of this procedure is to improve mobility for patients who have problems walking, running and doing day-to-day activities. It is also to relieve severe pain caused by disorders or diseases such as osteoarthritis, rheumatoid arthritis and many more.

Depending on the condition of the knee, there are two types of surgical treatments available:
Total Knee Replacement (TKR)
This is the most common form. Your surgeon replaces the surfaces of the thigh bone and shin bone that connects to the knee.

Partial Knee Replacement (PKR)
If arthritis affects only one side of your knee, this surgery may be a possibility. However, it is only suitable if you have strong knee ligaments. Partial knee replacement can be performed through a smaller cut than is needed for total knee replacement.

The knee is made up of 3 compartments: the medial (inner), the lateral (outer) and the patello-femoral. Any of these compartments can be replaced if they are diseased, without replacing the entire knee joint. Patient selection is crucial. Patients may therefore have an investigative key-hole procedure before undergoing their knee replacement, in order to ensure they are suitable for the planned procedure. Sometimes the decision is made at the time of the surgery. In either case, the best option would be one suited to the individual.

3. Meniscus Injury

The meniscus is a C-shape cartilage between the shinbone and thighbone that acts as a cushion protecting the joint surfaces of the knee. One of the most common injury that occurs is a torn meniscus. Not all meniscal tears require surgery. However, there are still a number of surgical treatments available here in SGH:
  • Resection
    During resection, the torn area will be removed along with the damaged tissue. Surrounding functioning tissues are preserved. This procedure is done through arthroscopy. Athletes can resume their sporting activities within 4 to 6 weeks. 
  • Repair
    Just like resection, the meniscus repair is carried out by arthroscopy method. Meniscal tears can be repaired by suturing the torn pieces together.
  • Transplantation
    This procedure applies to badly damaged meniscus that cannot be repaired. Damaged menisci are replaced with menisci obtained from a donor. 
4. Cartilage Chondroplasty and Microfracture
  • Cartilage Condroplasty
    The articular cartilage (lining of the knee joint) can be damaged by either an acute injury or repetitive wear and tear. Articular cartilage has less capability to repair itself once it has been damaged. The most commonly carried out procedure is chondroplasty. During the surgery, loose fragments of the cartilage are removed. The rough edges of the cartilage will be smoothened with a mechanized shaver. This procedure is reserved for small, shallow cartilage defects.
  • Microfracture
    Microfracture is a common technique used to treat damaged cartilage by making holes in the exposed bone. These holes will then allow blood to flow into the injured area, forming a blood clot. The blood clot contains specialised cells which have the potential to transform into new cartilage, to fill the cartilage defect. To allow the microfracture to work, patients are required to use crutches for 6 weeks following surgery and then have a gradual return to sport depending on the size and position of the lesion.

Shoulder

1. Rotator Cuff Repair

Damaged or torn rotator cuffs are commonly due to overused shoulder or the usual wear and tear. Symptoms of a torn rotator cuff vary but may include sudden or chronic shoulder pain that travels down to the arm causing its limited mobility. The type of tear will be diagnosed through imaging tests such as X-rays, Magnetic Resonance Imaging (MRI) or ultrasound. 
Type of tear:
  • Partial cuff tear
    With the right management and physiotherapy treatment, small cuff tears are able to heal successfully on its own.
  • Complete cuff tear
    The rotator cuff tendons do not have the ability to heal itself. Hence, a surgery is essential to repair the shoulder after a complete tear. 

Surgical treatments:
a. Debridement
Debridement surgery involves shaving and removing of loose shoulder muscle fragments around the joint. This procedure is intended to relieve the pain and other related symptoms. Debridement is done arthroscopically for partial tear repairs. 
b. Open repair
An open repair is recommended for more severe tear complex. A surgical incision is made and the deltoid is detached to have a better assessment to repair the tear. During the repair, suture anchors are used to help tendon attachment to the head of humerus. 
c. Arthroscopy repair
Arthroscopic repair is often used for patients with small- to medium-sized tears (about 3 cm or smaller). It is the least invasive of the three rotator cuff repair options. During this procedure, a small camera is inserted while the surgery is performed using smaller instruments. Similar to the open repair procedure, the tendon is attached to the humerus by suturing the torn edges together and adhering it to the top of the bone. 
d. Shoulder replacement surgery
In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).

2. Shoulder labral tear repair (Superior, Anterior and Posterior)

The term SLAP stands for Superior Labrum Anterior and Posterior. The labrum of the shoulder is a cartilage disc attached to the socket of the shoulder. The labrum functions by maintaining the stability of the shoulder.  That means that the labrum helps the shoulder stay in its proper place.  The ligaments which hold the shoulder bones together are also firmly attached to the labrum. In a SLAP injury, the top (superior) part of the labrum is injured. This top area is also where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. The biceps tendon can be involved in the injury, as well.

Patients can opt for either surgical or non-surgical repair. For surgical repair, the procedure is done by the arthroscopic technique. As there are several different types of SLAP tears, our surgeon will determine how best to repair the injury once they have seen it fully during arthroscopic surgery. This may require simply removing the torn part of the labrum, or reattaching the torn part using stitches. Some SLAP injuries require cutting the biceps tendon attachment.

Ligament

1. Extracorporeal Shock Wave (ESW) therapy

Extracorporeal shock wave therapy is a non-surgical method used to treat musculoskeletal conditions or injury. The therapy may also be used to treat conditions like degenerated tendons (Achilles tendonitis), heel pain (plantar fasciitis), tennis elbow (lateral epicondylitis) and other chronic pain. Patients with heart conditions, neuropathy are not recommended to opt for this procedure. 

During the procedure, a noninvasive probe is applied to skin. An electrical charge creates an energy wave on the targeted area. This creates a force on the tissue that causes the increase in cell membrane permeability which will enhance the circulation and metabolism. It was known that the shock waves cause inflammation and improve blood flow to encourage the body to repair and heal itself. This procedure is administered under local anaesthesia and lasts for 20 to 30 minutes per session. 

2. Platelet Rich Plasma (PRP) therapy

Just like the ESW therapy, the platelet rich plasma (PRP) therapy is a non-surgical technique. It is a procedure known to accelerate the healing process of injured tendons. Platelets are one of the components of blood. The primary function of the platelet is to aid in blood clotting process. 

To start the procedure, the patient’s blood is obtained and centrifuged to separate the platelets from the other blood cells. The separated platelets are injected into the injured area (bone or soft tissue), thereby releasing the growth factors that recruit the proliferation of reparative cells. Ultrasound can be used as guidance for the injection.