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Trinity Hospital Sports Injury Centre is one of its kind centre for sports injury management with specialized Orthopaedics,  state-of-the-art arthroscopic & minimally invasive surgery. It is dedicated to delivering the highest standards of integrated diagnostic, pre-habilitation, treatment, rehabilitation services for sports injuries. The Centre deals with Sports Injuries (Arthroscopy)& late sequelae of sports injury (Arthritis & Joint Replacement).

  • The centre is managed by dedicated staff consisting of OrthopaedicSurgeons, Anaesthetists, Staff Nurses, Technicians and Physiotherapists, who are fully trained and possesses requisite expertise in management of sports injuries
  • The Physiotherapy Unit is well equipped to provide physiotherapy/rehabilitative services to the indoor/outdoor patients with specialized treatment.
  • Ultra Modern OT complex comprises of four fully equipped Operation Theatre with laminar flow and HEPA filtration, the latest modular OT tables, OT lights, C-Arm imaging facility and modern Anaesthesia work station with attached PACU.

SERVICES

Knee

  • Meniscus surgery.
  • ACL surgery.
  • Complex & Multi-ligamentous reconstruction.
  • Cartilage surgery
  • Patellar stabilisation Surgery
  • Revision ACL/ PCL with allografts (Indian/Imported).
  • Realignment Osteotomy.
  • Unicompartmental knee and Patellofemroal joint replacements.
  • Total knee replacement

Foot & Ankle clinic

  • Ankle Arthroscopy
  • Heel pain syndrome
  • Hindfoot impingement
  • Tendoachilles mini open Repair
  • Flat foot correction

 

Meniscus Surgery

Menisci are two crescent-shaped (half moon) discs between the thigh bone (femur) and the leg bone (tibia). They serve as shock absorbers and have several other important functions too.

How does the meniscus tear?
Meniscal lesions are commonly seen above the age of 40 andmenisci can tear without significant injury. In rare instances when there is a developmental error (manufacturing defect !), the meniscus may be shaped like a disc instead of a half moon and it is then called a discoid meniscus. Such menisci are more prone to tear and may present as a painful or clicking or intermittently locked knee in children.
Complex meniscal injuries are associated with cruciate or multiligament injuries and are addressed during the ligament reconstruction procedure.

Arthroscopic view of meniscus with a tear

Arthroscopic view of meniscus with a tear

Symptoms of meniscus tears – 
A meniscus tear usually presents with pain in the inner or outer aspect of knee. In some cases patients presents with locking of the knee.

Does my Meniscus tear require surgery?
Only meniscal tears that cause pain, limp, restricted movements or locking (unable to straighten the knee) require surgery.  Occasionally, meniscal tears are associated with a cyst (commoner on the outer or lateral side). Meniscal surgery is generally a planned procedure however, in case of a “locked knee”, early surgery is advised to prevent joint damage. Arthroscopic view of meniscus with a tear

How is a torn meniscus managed?
Meniscus tears seen on MRI but not causing any symptoms are best left alone and do not need any intervention. Meniscal tears that cause symptoms of pain, limp, localised painful swelling or locking, benefit from arthroscopic surgery which is of two types –

  1. Meniscectomy – the damaged portion of the meniscus is trimmed and the healthy portion preserved
  2. Meniscal repair – where the torn meniscus is stitched back using specialised techniques / implants.

Note : Not all meniscal tears can be repaired as the meniscus does not have optimum blood supply throughout its structure. Feasibility of repair is based on the time since injury, type & location of the tear (red or white zone of the meniscus) and whether it follows an injury or is degenerative in nature. 

Can meniscal surgery be delayed?
Meniscal tears rarely heal on their own because of poor blood supply and with time, the tear often increases in size. Early intervention for symptomatic meniscal tears is therefore advisable

 

ACL surgery

The anterior cruciate ligament (ACL) is a crucial ligament for knee stability. It primarily prevents abnormal front movement of the tibia (leg bone) in relation to the femur (thigh bone).

A. How does the ACL tear?
The ACL does not tear without some form of an injury. These injuries may occur during sports, road traffic accidents or activities of daily living (slipping on a wet floor, jumping from a low height or even dancing) that result in a sudden change of direction (pivoting), jumping or landing awkwardly. In rare situations, minor twisting while walking on uneven surfaces may lead to ACL tears.

B. What happens when the ACL is torn?
A torn ACL may lead to an unstable knee that results in “buckling” on sudden change of direction. Buckling causes abnormal movement between the thigh bone (femur) & the leg bone (tibia). This leads to tears of the menisci (shock absorbing cushions between these bones) and the articular cartilage (protective lining of the joint) causing early arthritis. The aim of treatment is to prevent this abnormal movement either by surgery or in some cases physiotherapy and / or activity modification.

Arthroscopic view of a torn ACL

Arthroscopic view of a torn ACL

 

C.What is the initial management of ACL tears?
It is advisable to see a Dr soon after the injury only to confirm the diagnosis. In the early phase, this will be done primarily through radiological investigations as the knee is too tender to examine completely.
In most ACL injuries there is immediate knee swelling, pain, limp and restricted movement. The management of this early phase is relative rest, ice application & protection of the knee by a rigid or flexible brace followed by graded physiotherapy (prehab). During this phase one needs to be careful on slopes, uneven surfaces and must avoid twisting movements (pivoting) and jumping. This will protect the knee from buckling that will further damage the knee.
Early surgery is performed ONLY if the knee is “locked” or unstable even during activities of daily living.

D. When is ACL surgery performed?
ACL surgery is performed once the knee is pain free, not swollen, the muscles around the knee stronger through targeted exercises (prehab) and knee bending is satisfactory. In some cases this may be sufficient to manage the instability and no surgery is needed. However, if there is persistent instability, surgery (ACL reconstruction) is recommended.

E. How is the ACL reconstructed?
ACL reconstruction is done arthroscopically (key hole surgery).  Grafts from the patient (autograft) or rarely allografts(from cadavers) are used.
Subtle injuries to the capsule or other ligamentous structures may be detected during arthroscopic evaluation done at the time of ACL reconstruction. These deficits need to be addressed to prevent failure of the reconstructed ACL. Some of these reconstructions include the ALL (anterolateral ligament) or the PLC (poster-lateral corner).

Arthroscopic view of same case after ACL reconstruction

Arthroscopic view of same case after ACL reconstruction

 

Other Ligament surgeries

ACL  reconstruction is the commonest ligament surgery performed for restoring knee stability. However, the other 3 major ligaments i.e. the PCL, MCL & LCL may also tear following an injury and may need repair or reconstruction.

  • Posterior Cruciate Ligament (PCL) reconstruction: This is perhaps the strongest ligament of the knee and requires significant force for its failure. Impacts on the front of the knee (as in dashboard injuries in road traffic accidents) or a fall on a bent knee are the commonest modes of injury. Like ACL reconstruction, PCL reconstructive surgery is also fairly routinely done.
  • Postero-lateral complex (PLC) reconstructions : This area of the knee was largely overlooked but is now better understood. Injuries to this area are often associated with ACL or PCL tears and need to be addressed with reconstructive procedures.
  • Lateral or Medial Collateral Ligament (LCL or MCL) reconstructions: These are 2 ligaments running on either side of the knee. They are usually injured during sideway impact to the knee. Occasionally they may also need repair or reconstruction depending on the severity / grade of tear.