Sports and orthopaedics injury surgery in Greenwich

Dr Adel Tavakkolizadeh, Consultant Orthopaedic & Upper Limb Surgeon at The Blackheath Hospital, explains that the most common causes of joint pain and injuries related to sports and physical activity that make people see a GP are:

• Back pain and injuries
• Knee pain and injuries
• Shoulder-related pain and injuries

Back injuries

Most of the time, these occur due to poor lifting technique or suddenly lifting heavy weights despite not being in good overall physical shape. Sometimes, back injuries can result from a traumatic incident like a motorbike accident.

“Most [cases of] back pain are generally soft tissue related and just need application of good technique, good regular exercise, and gradual buildup to ease it off,” explains Dr Tavakkolizadeh.

Knee injuries

“Knee soft tissue injuries are incredibly common,” explains Dr Tavakkolizadeh, “and at the top of the list is anterior cruciate ligament (ACL) injury.”

What is the ACL?

The ACL is a ligament that runs diagonally inside the knee joint. The two bones that make up the knee joint are the tibia, or the lower leg bone, and the femur or the thigh bone. The ACL stops the tibia from slipping in front of the femur and enables the knee to rotate safely and with stability.

In other words, this ligament controls rotation and the forward movement of the shinbone.

What is an ACL injury?

“ACL injuries generally happen with pivoting-type sports — sports where you are suddenly changing direction — and that’s why it’s very common in basketball, football, racquet sports, and it’s very common in younger age groups,” explains Dr Tavakkolizadeh.

Symptoms of an ACL injury include:

• A popping sound or sensation when the injury happens
• Swelling
• Pain
• Inability to bear weight on the leg or move the leg/knee fully
• Knee instability

The pain and swelling may go away on their own in the first 24 hours to a few weeks, explains Dr Tavakkolizadeh. However, if you return to sports, your knee will likely continue to be unstable, and you may cause further damage. This happens because “unfortunately when a ligament is torn, it remains torn.”

Surgical intervention may ultimately be necessary. “Surgery can make the knee more stable, [...] improve symptoms and function, and get people back to a normal level of sporting activity,” he says.

Injuries to other ligaments

In addition to the ACL, there are three other ligaments in the knee that can sustain a sports-related injury:

• The posterior cruciate ligament (PCL) is in the centre of the knee. It controls the backward movement of the shin bone. The PCL tends to get injured in sudden direct blows, such as in a car accident or during a soccer tackle.
• The medial collateral ligament (MCL) stabilises the inner knee.
• The lateral collateral ligament (LCL) stabilises the outer knee. Injuries here tend to occur due to sudden direct impact on the outer side of the knee, like, for example, in hockey or soccer.

Meniscus injuries

The meniscus is a small piece of cartilage between the tibia (shinbone) and the thigh bone. It is shaped like a crescent moon, or like the letter ‘C’, and it acts as a shock absorber — protecting the lower leg from the shock of your body weight.

Meniscal tears tend to occur when an athlete twists or turns their leg. Common symptoms of a meniscus tear include:

• Pain inside the knee joint, outside of it, or at the back of the knee
• Swelling
• A catching or locking sensation in the knee
• Inability to fully extend or fully bend the knee
• Limping

“Many meniscus injuries can settle by themselves and don’t require intervention,” explains Dr Tavakkolizadeh. But if the pain persists and does not get better with time, physiotherapy, and rehabilitation, you may need further intervention.

“A general advice is that if a knee has had a significant injury where there is a clear, traumatic episode, which is immediately followed by significant swelling and pain, and if it really causes restriction of movement and mobility — they should be reviewed by someone in the early stages: by a physio or a GP.”

Other lower limb injuries

Other common lower limb injuries that can require surgery may occur in the hip, ankles, or spine. They include:

• Hip impingement
• Achilles tendinopathy
• Lateral ankle ligament sprains
• Ankle osteochondral lesions
• Disc herniation and disc degeneration disease

Injuries around the foot and ankle are very common, Dr Tavakkolizadeh explains. The main issue here tends to do with overuse. “During a lot of running, you can get issues around plantar fasciitis, which is a pain in the sole of the foot, and you can get issues with pain in the tendons around the ankle such as the Achilles tendon, which is common in runners.”

Ligament sprains around the ankle are also frequent, the doctor adds, particularly in the case of people who were not active for an extended period and started overdoing the exercise. This increases the risk of sustained stress fractures in the lower limbs.

Ankle sprains make up 40% of all athletic injuries in professional athletes.

Shoulder injuries

“In the younger age group,” Dr Tavakkolizadeh says, “the classic injuries we see are shoulder instability or dislocations, which are pretty common after contact sports, such as rugby.”

These injuries “disrupt some of the important internal structures within the joints, very similar to the cruciate ligament problems in the knee. And unfortunately, once those structures are damaged, they don't tend to repair themselves naturally.”

“That's why, statistically, once you dislocate your shoulder once, you are more likely to continue having further dislocations in the future,” Dr Tavakkolizadeh adds. “And that partly depends on the sport you do and how old you are when this happens.”

Rotator cuff injury

Most commonly, a group of tendons around the shoulder — called rotator cuff tendons — can get injured due to a traumatic episode. Normally, your rotator cuff enables you to lift your arms all the way up. But accidents such as falling suddenly on your outstretched hand may injure these tendons.

Common symptoms of rotator cuff injury include:

• Persistent pain
• Pain at night
• Crackling sounds when moving your arm
• Limited mobility in the arm
• Weakness in the shoulder

Other upper limb injuries

Other common injuries of the upper limbs, explains Dr Tavakkolizadeh, include wrist and hand injuries that also tend to occur when you fall on your outstretched hand.

“You can sustain a fracture around the wrist or one of the little bones around the wrist such as the scaphoid bone, typically in sports that involve a lot of falling — rollerblading, skateboarding, skiing, snowboarding.”

If there is immediate pain and discomfort, Dr Tavakkolizadeh cautions, you may need an x-ray.

First, the possibility of a fracture must be ruled out, explains Dr Tavakkolizadeh. “If there is genuine concern that there is a bit more than just a soft tissue injury, we advise that [the patient] be seen even earlier, possibly through an emergency department to have an x-ray and make sure there are no fractures.”

If it is established that there is no fracture but only a soft tissue injury, these could go away on their own.

“Most simple injuries tend to recover pretty quickly in the first few weeks. Anything that lingers and continues to cause a problem may need further investigations and treatment,” advises Dr Tavakkolizadeh.

“The body is amazingly good at fixing itself,” he adds. But cases “where there is a complete disruption of a ligament or a tendon may need to be [...] considered for surgical interventions. And that's because those are the structures that, unfortunately, once completely damaged or torn, are not very good at repairing themselves.”

Partial sprains or other partial injuries may resolve on their own. But “it’s specific complete disruptions of ligaments and tendons, where more invasive interventions may need to be considered.” In these cases, further investigations such as x-rays, MRI scans or ultrasound scans will be necessary to assess the problem before deciding on surgery.

Before considering surgical intervention, there are many conservative treatment methods and strategies that can help with your injury, including:

• Rest
• Nonsteroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen
• Applying ice
• Compressing the area using a brace or an elastic bandage
• Strengthening and stretching exercises through physiotherapy 
• Steroid injection therapy

“Medicine in orthopaedics has progressed a lot in the last two decades,” Dr Tavakkolizadeh explains. “There are a lot of interesting things coming along [such as] biologics and using stem cells to improve soft tissue repair and healing, such as platelet-rich plasma techniques.”

If your injury requires surgery, your consultant may recommend arthroscopy.

Arthroscopy, or keyhole surgery, is a minimally invasive operation that can treat knee, shoulder, and ankle injuries, among others.

During the procedure, your consultant will make a small incision in the joint and insert a small arthroscope — an optic tube with a light attached. The tube’s camera will transmit images to a screen, which will guide the surgery. Then, using an additional incision and small surgical instruments, your consultant will repair or cut out the damaged part of cartilage or tendon in the joint.

Knee arthroscopy for meniscus tears

In knee arthroscopy for meniscus tears, the consultant will either repair or cut out the damaged portion of the meniscus (meniscectomy), preserving as much of it as possible. In the case of a meniscus repair, sutures will be used to hold the meniscus together while it heals.

Studies show that 80–90% of high-level athletes in sports such as basketball, American football, or baseball return to sports after meniscus repair. By comparison with meniscectomy, meniscus repair has better outcomes in terms of:

• Symptoms
• Knee function
• Return to sporting activities

Knee arthroscopy for ACL injury/ligament repair surgery

In this procedure, the consultant will use the arthroscopy technique to reconstruct the ACL using a section of another tendon from around the knee. This is called a graft.

The consultant will create one or two small incisions in the knee, take grafts from other tendons in your body (such as the patellar tendon or the hamstring tendon), and drill a small tunnel or hole into the tibia and one in the femur. Then, they will thread the graft across the knee through the tunnels.

This way, the grafted tendon is placed where the original ACL used to be, thus reconstructing the ligament. Finally, the graft is secured with screws, sutures, or other fixation techniques.

Benefits of ACL repair surgery

This surgery offers several benefits, explains Dr Tavakkolizadeh, such as “giving stability to the knee and improving the biomechanics of the joint to try to reduce the risks of developing further problems down the line, such as early-onset arthritis.”

Between 63% and 92% of people who undergo ACL repair go on to return to sports. Of those undergoing PCL repair, 67% return to competitive sports after the surgery.

Risks and complications of ACL repair surgery

Most patients recover from the procedure without any complications. However, there are risks with ACL repair surgery, as with any other surgical procedure. These risks include:

• Bleeding
• Infection
• Blood clots
• Swelling in the knee

The most common complications of ACL repair surgery are:

• Pain: experienced by 10–20% of patients
• Limited mobility in the knee joint: experienced by under 5% of patients

Arthroscopy for shoulder injuries

“Shoulder arthroscopy, which is effectively the keyhole surgery of the shoulder, is an incredibly common procedure,” explains Dr Tavakkolizadeh.

Shoulder arthroscopy “is nowadays our default technique to doing pretty much most of the operations that we need to do around the shoulder,” he adds. These include:

• Shoulder stabilisations for people with recurrent shoulder dislocations
• Rotator cuff repairs
• Conditions that cause shoulder pain, such as impingement
• Frozen shoulder that is resistant to treatment

According to Dr Tavakkolizadeh, the advantages of shoulder arthroscopy compared with open surgery are:

• Reduced pain after surgery due to the smaller incisions
• Smaller scars
• Quicker recovery time

As with any other arthroscopic surgery, however, there are also risks. These include excessive bleeding, infection, blood clots, or nerve damage.

Rotator cuff surgery: benefits and risks

Rotator cuff surgery may be done through arthroscopy, open surgery, or a combination of both.

The surgery is meant to repair the injury either by shaving off bone spurs that are pinching the shoulder or by repairing the actual torn tendon or muscle in the shoulder. Bone spurs, or osteophytes, are overgrowths of bone tissue that look like bony lumps. 

Using sutures, your consultant may repair the rotator cuff tear by reattaching the tendon to the top of the humerus (the long bone of the upper arm).

The benefits of rotator cuff surgery are:

• It helps restore the function of the shoulder
• It helps restore mobility of the shoulder
• It helps relieve pain

Most people have no complications from this surgery, but as with any surgery, possible risks include:

• Excessive bleeding
• Infection
• Blood clots
• Persistent shoulder pain and weakness
• Limited mobility in the shoulder
• Nerve damage

Dr Tavakkolizadeh is one of The Blackheath Hospital’s 47 highly qualified specialists in orthopaedic surgery.

“Having worked at The Blackheath Hospital for a number of years, I would say that the great asset about the hospital is that it is a very friendly, progressive working environment,” he says. “They also have fantastic facilities, which are constantly being upgraded,” he adds.

“The development of the hospital also means that we have some HDU [high-dependency unit] facilities that enable us to do the more complex cases and more complex surgeries. That is not always possible in all private hospitals,” adds the consultant.

Undeniably, cost is an important part of your decision to undergo surgery. The Blackheath Hospital offers fixed-price packages which include:

• An initial consultation
• Treatment
• Aftercare

A breakdown of costs is available for various sports and orthopaedic injuries, including:

• ACL reconstruction surgery
• Ankle surgery and ankle arthroscopy
• Knee arthroscopy
• Rotator cuff surgery
• Shoulder replacement surgery

We also offer flexible payment options if you are paying for the treatment yourself.

If you have private health insurance, you can use it to pay for care at The Blackheath Hospital.

If you are struggling with a sports injury and you are looking for quick and easy access to the right treatment for you, book a private consultation with us today. You can book online or call us on 020 8318 7722 to speak with one of the friendly team.

The Blackheath Hospital in London is in the centre of Blackheath village, a stone's throw from the Blackheath train station. It is easily accessible to patients living in Greenwich, Lewisham and Bexley via the M25, A20 and A2.

It is located at 40–42 Lee Terrace, Blackheath, London, SE3 9UD. For instructions on how to get to us by road, train, or bus, click here.

We look forward to welcoming you to The Blackheath Hospital and helping you to get back to your normal active lifestyle as quickly as possible.