A sports injury can be quite devastating, especially when it doesn’t resolve quickly.
Surgery is rarely considered a first-line treatment because it’s invasive and always requires a degree of risk. For most injuries, you’ll be advised to follow a course of conservative treatment first, which may include medication, rest, physiotherapy and regular assessment of your progress.
Conservative treatment works well for many people. But not for everyone – and not for all injuries. Some are more likely to require surgery. Let’s look at a few.
ACL injuries
The anterior cruciate ligament (ACL) provides support and stability to your knee, especially when you’re engaged in fast movements like pivoting and twisting. Rupturing your ACL can be intensely painful and the associated instability can leave you feeling like your knee could give way.
Non-surgical treatment can yield positive results, most commonly for people who:
- Have no other injury to their knee
- Are playing lower levels of sport
- Are willing and able to complete a comprehensive rehab program overseen by physiotherapists and surgeons who are skilled at managing ACL injuries.
However, ACL injuries can be complex. Surgery may prove the most beneficial option for people who:
- Have injured more than one ligament in their knee
- Have only injured their ACL but continue to experience instability
- Wish to play pivoting or twisting sports.
The preferred surgery is usually reconstruction rather than repair (which is often not possible). Reconstruction surgery is performed using a graft from another tendon in your body, such as your hamstring, patella tendon or quadriceps tendon. It is also possible to use donor tissue or a synthetic graft.
Following your surgery, you’ll complete a program of rehabilitation with the goal of enabling a staged return to your chosen sport.
Meniscus tears
Two pieces of fibrocartilage, known as the menisci, are wedged between your thighbone and shinbone. They help absorb shock and transmit weight from one bone to another. They also play an important role in knee stability.
Both contact and non-contact sports can lead to a meniscus tear. Initially, you might feel able to go on playing but you’ll often notice that your knee stiffens and swells over the next few days.
If your symptoms persist despite conservative treatment, then arthroscopic (keyhole) knee surgery may be considered. Surgical options could include:
- Partial meniscectomy to trim away the damaged meniscus tissue. Recovery is relatively quick.
- Meniscus repair to stitch the torn pieces together if possible. Recovery from this procedure takes a little longer because the sewn parts of the meniscus must heal together.
Shoulder labral tears
The labrum is a specialised cartilage that lines and reinforces the ball-and-socket shoulder joint. It helps stabilise your shoulder and is the attachment point for other soft tissues like ligaments and tendons.
Labral tears may occur alongside a shoulder dislocation or if you experience sudden force to the shoulder when your arm is fully extended. Common causes of shoulder labral tears include weight lifting and ‘overhead sports’ like swimming, tennis, volleyball or throwing events on the track and field.
If symptoms persist despite conventional methods, then surgery may be required to reattach the torn ligaments and labrum to the bone. Usually this is done with a minimally invasive surgical procedure.
Surgery may prove the best way forward for young athletes playing high-impact sports requiring a powerful shoulder.
Severe fractures and dislocations
Fractures are usually the result of acute traumas such as a fall, a car accident, a bad tackle or collision on the pitch. Repetitive activity like running may also increase the risk of a fracture.
Your bone can break in many different ways, meaning fractures vary a great deal.
Some types can be resolved without surgery. Your doctor may:
- Immobilise it in a splint or cast – especially if your fracture is mild and your bones did not move far out of place
- Perform a closed reduction to realign your bones. You’ll be given pain relief or sedation while your doctor pushes and pulls the injured bone to line it up properly again then puts it into a splint or cast.
More severe fractures and dislocations require surgery to put the damaged and displaced bones back where they should be. Your bones may need to be fixed in place with rods, screws, pins or wires. You may need bone grafts or even a replacement joint, depending on the nature and severity of your injury.
After surgery, your bone will be immobilised to promote stability and healing. As your recovery progresses, you’ll usually require physiotherapy to regain strength and range of motion and to ensure you return to sport at the right time and in a careful manner.
How Dr Ross Radic can help
I’m an experienced orthopaedic surgeon who treats many elite athletes using a multidisciplinary approach.
I have extended expertise in all aspects of knee surgery, particularly ACL reconstruction, robotic knee replacement, multi-ligament knee reconstruction and limb realignment. I’m also fellowship trained in shoulder surgery, with a focus on arthroscopic shoulder procedures, sports surgery, and hip and shoulder replacement.
As a surgeon, I work closely with providers of conservative treatment like physiotherapists and doctors. We work collaboratively with you to assess whether conservative treatment is likely to succeed and to design the right plan for you. We also monitor your progress and, if your condition is not improving, we then review the case for surgery.
Conservative treatment may also help you get into better shape prior to your surgery to maximise results.
Using a minimally invasive approach to surgery wherever possible helps to reduce surgical risks and promotes a speedier recovery.
Once your surgery is done, that prehab becomes rehab, a program of exercises designed to rebuild your strength, flexibility and range of motion so you can get back to sport.
If you’d like an assessment of your injury, please contact me (you’ll need a referral before your appointment).
Disclaimer
All information is general and is not intended to be a substitute for professional medical advice. Dr Ross Radic can consult with you to confirm if a particular procedure is right for you. A second opinion may also help you decide on the way forward.