Document 1468803

Transcription

Document 1468803

Delhi Arthroscopy
Course-2015
(Under aegis of Indian Academy of
Arthroscopy & Sports Medicine)
Date : 27th & 28 June, 2015
Venue : Le Meridien, New Delhi
A Non Stop Live Surgery Bonanza is Back
Team - Sports Injury Centre
L to R : Dr. Pallav Mishra, Dr. Himanshu Gupta, Dr. Ajay, Dr. Vivek Shankar, Dr. Nitin Mehta, Dr. Ankit Goyal,
Dr. Himanshu Kataria, Dr. Vineet Jain, Dr. Deepak Chaudhary, Dr. Deepak Joshi.
Center : Dr. Rajpal, Director Professor & Medical Superintendent, Safdarjung Hospital
Delhi Arthroscopy
Course-2015
(Under aegis of Indian Academy of
Arthroscopy & Sports Medicine)
Date : 27th & 28 June, 2015
Venue : Le Meridien, New Delhi
A Non Stop Live Surgery Bonanza is Back
Delhi Arthroscopy Course-2015
Organising Team
CHIEF PATRON
Dr. Rajpal
Director Professor and Medical
Superintendent, Safdarjung Hospital
Dr. Ashok Rajgopal
Organising President
Dr. V.B. Bhasin
Organizing Chairman
Dr. Deepak Chaudhary
Organizing Secretary
Dr. Deepak Joshi
Chairman-Scientific and
Souvenir Committee
Dr. Himanshu Kataria
Dr. Amite Pankaj
Chief advisor
Dr. Ravi Gupta
Treasurer
Dr. Vineet Jain
Joint Organizing Secretary
Dr. Ankit Goyal
Dr. Nitin Mehta
Course Coordinators
Dr. Ajay
Dr. Pallav Mishra
Dr. Himanshu Gupta
Dr. Vivek Shankar
Scientific Committee-Advisors
Dr. H L Nag
Dr. Vinod Kumar
Dr. I P S Oberoi
Dr. Pushpinder Bajaj
Dr. Shekhar Shrivastav
Sports Injury Centre - Our Pride
Messages
Message
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Message
Health Minister
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Message
Secretary Health
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Message
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Message
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Message
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Message
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Message
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Message
Bishan Singh Bedi
Former Captain Indian Cricket Team
Message
It gives me immense pleasure to know that Sports Injury Centre, Safdarjang Hospital
is holding 3rd Delhi Arthroscopy Course on 27th and 28th July, 2015 at Hotel Le
Meridian, Delhi. I believe that it's one of its kind of course where arthroscopic
doctors and Sports Medicine doctors from all over the country come to watch live
surgeries being conducted at Sports Injury Centre. Given the expertise of the centre
in performing such surgeries, it is appropriate that the centre is holding such a course
for the benefit of other doctors in this field.
India is known world over for expertise of its doctors and now it is heartening to see
that there is a growing number of doctors interested in sports medicine and provide
treatment for various injuries to our sportsperson here in India only. This will enable
lot of players to back to sports after injury, something which was difficult for lot of
players especially budding or junior players.
I have been associated with Sports Injury Centre right from its inception and it is
heartening to see it grow from strength to strength. I congratulate the team of Dr.
Deepak Chaudhary for this effort and wish them success in their endeavour.
Bishan Singh Bedi
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Message
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Message
Dr. V B Bhasin
Consultant Arthroscopic Surgeon
Sir Ganga Ram Hospital
President Indian Arthroscopy Society & Organizing Presidnet
Message
Sports injury center is a world class facility with a very committed and capable faculty
and staff of nurses physiotherapist and technicians. It is doing phenomenal work in
the field of Arthroscopy. Holding a course where such a large number of operations
are shown live for teaching is only possible in this center in our country . Sports
injury center started as small clinic way back in 1993. It was with the dedication and
hard work of the present director who started the clinic in 1993 that this center has
blossomed into a center of excellence in the present state. A well co ordinates team
has been built over the year which is successfully conducting the course.
I wish the best for this course and the team at the sports injuries center.
.
Dr. V B Bhasin
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Message
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Message
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Sky is the limit
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The Sports Injury Centre: Setting new Standards of Excellence in
Sports Medicine & Arthroscopy
Dr. Deepak Chaudhary
Director, SIC
The Sports Injury Centre at Safdarjang Hospital has evolved over the past 4 years as a 'Centre of
Excellence' providing integrated surgical, diagnostic and rehabilitative services under one roof
benefitting sports persons in particular as also the general public at large. During the last four years the
team of doctors at SIC have
performed more than 7000 complex
surgeries. Some of these surgeries
were very rare and have been
performed for the first time not only in
India but have also been the first
globally. A few of such surgeries which
can be named here are Autologous
Chondrocyte Implantation, ALL
(Anterolateral ligament of knee)
Reconstr uction, AC Joint
Reconstruction, Tibial Spine Fixation
using mini tight rope, Double Bundle
Reception
ACL/PCL Re-construction, Multiple
Ligament Reconstructions of Knee, Double Row Rotator Cuff Repair, OATS, Meniscal Repairs etc.
Out Patient Department
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The Centre has made tremendous progress in providing integrated surgical, diagnostic and rehabilitative
services under one roof for treatment of sports & related injuries and disorders. One of the very
rewarding returns for the Centre has been its track record of successfully treating and rehabilitating
many sports persons who have taken back to their active sporting lives after their surgeries/treatment.
On the academic front, the Centre has anchored a number of national and international conferences
which have been attended and appreciated by the visiting faculty from various countries. The Centre is
recognized by the International body of Sports Medicine for imparting training to young orthopaedic
surgeons. It has also been approved for award of a fellowship (FNB) by the National Board of
Examinations which is first of its type in the country. This fellowship is offered to post graduates in
orthopaedics who wish to pursue further super-specialty training in the field of Arthroscopy and
Sports Medicine.
The Central Government has also approved starting of MD (Sports medicine) course at SIC with
annual intake of four students from the academic year 2015-16. Safdarjang Hospital will be the first
institution in a government setup starting MD in Sports Medicine under Guru Gobind Singh
Modular Operation Theatre
Patients in Out Patient
Department
Conference
Hall
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Indraprastha University from 2015. The team of IP University which inspected the faculty and facilities
at Sports Injury Centre recommended intake of 4 students in MD Sports Medicine for the year 2015-16.
Out of the four students, 2 will be admitted from examination conducted by IP University and 2 from All
India MD/MS entrance examination. Starting of Sports Medicine,education at SIC will help to generate
a pool of qualified doctors who will apart from dealing with injury prevention and treatment, also help in
devising sport specific protocols for performance enhancement.
Sports Injury Centre is only one of the select few centres which has been approved by ISAKOS as an
approved teaching and training centre for young surgeons.
ISAKOS Certificate
Sports Injury Centre, Safdarjung Hospital, New Delhi
New Delhi, INDIA
is recognized as an ISAKOS Approved Teaching Center
This facility has been approved to host surgeons who
request further training and/or exposure to
arthroscopy, knee surgery and
orthopaedic sports medicine
Joao Espregueira - Mendes, MD, PhD
Education Comm . Chair
ISAKOS
Moises Cohen, MD, PhD
, ISAKOS President
2011 - 2013
The Centre alongwith Deptt. of Anatomy and Forensic Medicine regularly conducts Arthroscopic
Cadaveric Workshops at VMMC and Safdarjang Hospital which is attended by delegates from all over
India and abroad. The delegates are imparted hands on experience on cadavers to enhance their
arthroscopy skills.
The SIC has taken the initiative to host a number of international arthroscopy conferences. This is the
third edition of Delhi Arthroscopy Course. In this course the delegates are exposed to an extravaganza
of wide array of Live Surgeries, a rare feat which enhances the learning experience of other doctors
from different areas who want to enhance their skills
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Prominent Sports persons who have
received treatment at SIC
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Chaobi Devi, an international Wushu player was operated for ACL
reconstruction . She won Gold medal at an international event post surgery.
•
Thyagaraj Basanta was operated for Bankart's repair and rotator cuff repair.
He won a Gold medal at International Police Meet in weight lifting.
•
Devrath an international wrestling player was operated for lateral meniscus
tear. Post surgery he won the title of Bharat Kesari.
•
Parvesh Rathi, a national basketball player was operated for ACL
reconstruction (Left). He resumed his sports and won a bronze medal at
National Games in Feb 2015.
•
Rajni Bala, a Judo player was operated for ACL reconstruction (Left). She
resumed her sports to win bronze medal in International South Asian
Championship (Nepal) in April 2014.
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Anuradha was operated for ACL reconstruction (Right) and won Bronze
Medal in Police Games 2012 post surgery.
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Manoj Gehlot, a Judo player won Bronze Medal in Senior National
Championship in 2012-13.
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Kuldeep singh a Gold Medalist at Commonwealth Games was later operated
for arthroscopic removal of loose body from his elbow. Two months back
he has been operated again for Double Bundle ACL reconstruction.
•
Other eminent personalities who have received treatment at SIC are,
Raghvendra Singh Rathore (Shooting), Sushil Kumar (Wrestling), Kripa
Shankar (Coach of Sushil Kumar), Jagbeer Singh (Hockey).
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Facilities at Sports Injury Centre
Sports Injury Centre is a unique Centre one of its kind in India, dedicated to delivering the highest
standards of integrated diagnostic, therapeutic and rehabilitation services for sports injuries. It is
situated inside the campus of VMMC and Safdarjung Hospital, Delhi.
It was inaugurated by the Hon'ble Prime Minister of India on 26th September, 2010 before onset of the
Commonwealth Games, 2010. The Centre is housed in a separate seven storey building with two
basements.
•
The Centre has a dedicated floor equipped with the latest electrotherapy machines with a separate
hydrotherapy wing including chilled shower, sauna, pool besides a cardio gym and strength gym. A
Biomechanical lab which has stimulator for the training of budding arthroscopic surgeons and an
isokinetic machine which is valuable for monitoring post-operative rehabilitation are also available at
the Centre.
• It houses state-of-the-art 24x7 Laboratory, Imaging Centre with latest equipments for routine and
advanced diagnostic services including Digital X-ray, CT Scan, MRI and Bone Densitometry. They
have been outsourced under Public Private Partnership mode with M/s P. Bhasin Path and with Lab
M/s Mahajan Imaging respectively. These tests/Radiological and Imaging examinations are
conducted on CGHS approved rates for all patients and the services are provided round the clock.
This provides affordable and reliable investigations with the convenience and hospitality associated
with private partners.
• All these facilities are provided with aim to give complete state of art diagnostic, therapeutic,
rehabilitation services to patients under one roof keeping their comfort in mind.
The Centre aims to provide excellent patient care as per international standards.
• The Centre comprises of highly specialized doctors working in Sports Injuries (Arthroscopy) and
late sequel of Sports Injuries (Arthritis and Joint Replacement Surgery).
• They are supported by dedicated staff consisting of Orthopaedic Surgeons, Anaesthetists, Staff
Nurses, Technicians and Physiotherapists, who are fully trained and possesses requisite expertise in
management of sports injuries
• One of the unique features of this Centre relates to Physiotherapy Unit, which is well equipped to
provide rehabilitative services to the indoor/outdoor patients with specialized treatment through
Hydrotherapy, Biochemical and Isokinetic muscle testing.
• The centre is equipped with State of the art Modular Operation Theatre and Gas Manifold System
with latest equipments for infection prevention and effortless surgery.
SIC is also making endeavours to get its surgeons well equipped with the latest medical practices
prevalent across the Globe through conferences and workshops.
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Diagonstic
X-Ray
MRI
Laboratory
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Therapeutic
Modular OT
OT
Post Operative Room
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Therapeutic
Ward
Ward
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Rehabilitation
Strength Gym
Strength Gym
Cardio Gym
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Rehabilitation
Hydrotherapy Pool
CPM-for gaining range of movement
Vacummed-for faster recovery after sports
Trampoline
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Rehabilitation
Customised care by Physiotherapist
Electrotherapy
Elbow CPM
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Types of Surgeries Performed at
Sports Injury Centre
HIP
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Hip arthroscopy, Total hip replacement (THR), core decompression.
KNEE
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Total knee replacement, High Tibial Osteotomy
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ACL reconstruction- Double Bundle/ Single Bundle
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PCL reconstruction- Double Bundle/ Single Bundle
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PLC reconstruction- MCL/LCL reconstruction
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MPFL reconstruction
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Autologous Chondrocyte Implantation (ACI)
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OATS
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Microfracture
ANKLE
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Impingement
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Arthoscopy, microfracture
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Tendoachilles repair
SHOULDER
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Bankart/Remplissage/SLAP/ rotator cuff repair
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Latarjet
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AC joint stabilization
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Biceps tenodesis
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Subscapularis repair
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Pectoralis major repair
ELBOW
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Biceps tendon repair, elbow arthoscopy
Conferences Organised by
Sports Injury Centre over past five years
• Shoulder Arthroscopy Workshop on Jan 22, 2011.
• Indian Arthroscopy Society Annual Conference- Live
surgeries, 2011.
• High Tibial Osteotomy on Jan 22, 2012.
• Delhi Arthroscopy Course 2013, 2014, 2015.
• Cadaveric Course in Knee and Shoulder Arthroscopy in
2011, 2012, 2013, 2014, 2015. (Held 3 times a year).
Delhi Arthroscopy Course 2013
Delhi Arthroscopy Course 2014
Cadaveric Course
Cadaveric Course
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In the Media
Media reports on some of the rare surgeries performed at
Sports Injury Centre in last 5 years
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AAr SAMAr (Wed, 23rd March, 2011)
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In the Media
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In the Media
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Expressions
Comments of Eminent Dignitaries and Sports persons who have visited Sports Injury Centre
over past 5 years
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Expressions
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Expressions
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Expressions
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Expressions
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Expressions
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Expressions
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Proud to work as a Team
L to R : Dr. Vivek Shankar, Dr. Pallav Mishra, Dr. Ajay, Dr. Vineet Jain, Dr. Himanshu Kataria,
Dr. Deepak Chaudhary, Dr. Deepak Joshi, Dr. Ankit Goyal, Dr. Nitin Mehta, Dr. Himanshu Gupta
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Delhi Arthroscopy1 Course-2015
Mind matters- “Role of Sports Psychology in Rehabilitation”
Dr. Shweta Tandon
Assistant Professor, Sports Psychologist, Sports Injury Centre
VMMC & Safdarjang Hospital
ports Psychology is the subspecialty of psychology that applies and develops psychological
strategies to enhance and optimize athletic performance. Engaged in a variety of myriad roles ,the
sports psychologists can teach skills to help athletes enhance their learning process and motor
skills, cope with competitive pressures, fine-tune the level of awareness needed for optimal
performanceand help them stay focused from distractions of team, travel and competitive
environment.
S
Adversity causes some men to break; others to break records."- William A. Ward (Inspirational Writer)
Injury is a common occurrence and one such adversity in sport participation. Sport injuries frequently
have profound negative consequences on the physical health of sports participants. They also have the
potential to cause a great deal of psychological disturbance through increased anger, depression, anxiety,
tension, fear, and decreased self-esteem. Sport injuries often result in an immediate imbalance and
disruption to the lives of the injured athletes including loss of health and achievement of athletic
potential and in extreme cases, injuries result in a permanent disability or even death and such functional
loss or the inability to continue sports participation can be devastating and hinder the recovery process,
and consequently affect the way athletes mentally deal with future injuries. Thus, including a component
that addresses psychological recovery from a sport injury in the traditional injury rehabilitation program
becomes critical to preventing and/or reducing negative psychological consequences resulting from the
injury and promoting return to active involvement in sport-related activities.
Advances in medical treatments have reduced the time required for physical healing, which may result in
athletes who are physically healed and ready to return to play but not yet psychologically recovered. This
potential discrepancy between psychological and physical recovery calls for increased attention to the
recovery process for injured athletes.
Therefore the first step in this direction is conducting a pre-operative assessment by the psychologists
for those patients scheduled by surgery for injuries. This would include assessing readiness for surgery,
responses immediately after surgery, predictors of rehabilitation adherence, frequency of intrusive
thoughts and avoidance behavior. Positive adaptation can be helped by reducing the uncertainty
surrounding rehabilitation and the recovery process. Therefore it includes an educative component.
Post operatively the role of the psychologists is helping injured athlete's in their rehabilitation program
by helping them understand nature and severity of the injury, prognosis for recovery ,estimate of the
time needed before training can be resumed, helping them set realistic goals for recovery(avoiding
overuse/overexertion injuries),increasing motivation to adhere to rehabilitationregimens, helping in
identifying and modifying faulty cognitions regardingrecovery, teaching positive self-talk and
management of pain.Therapy also addresses issues related toerosion of self-esteem by injury and how
this can be salvaged by alternative activities
Athletic injury, whether temporary or permanent, is and always will be a painfully disruptive and
uncontrollable interruption in an athlete's life.Thus the goal of the rehabilitation program is the
rehabilitation of the athlete and not just the injury.
"Out of suffering have emerged the strongest souls; the most massive characters are seared with scars."
- Khalil Gibran
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Prevention of Sports Injuries
Ms Harmit Bawa
(MPT)
Physiotherapist Sports Injury Centre
P
articipation in individual or team sports is a great way for both children and adults to keep active.
Regular physical activity through sport participation offers a range of health and social benefits.
Despite the many benefits, participation in sport is not without some risks, particularly the risk
of injury. Sports injuries can vary in severity ranging from minor bruises to major bone fractures. The
potential for injuries should not dissuade individuals from participating in sport especially given that in
some cases they may be preventable. Following are some of the ways to prevent sports related injuries.
1) Proper Preparation for Play
• Maintain fitness. Be sure you are in good physical condition at the start of season. During the offseason, stick to a balanced fitness program that incorporates aerobic exercise, strength training, and
flexibility. If you are out of shape at the start of the season, gradually increase your activity level and
slowly build back up to a higher fitness level.
• Pre-season physical. All players should have a pre-season physical to determine their readiness to play
and uncover any condition that may limit participation.
• Warm up and stretch. Always take time to warm up and stretch, especially your hips, knees, thighs and
calves. Research hasshown that cold muscles are more prone to injury. Warm up with jumping jacks,
running, or walking in place for 3 to 5 minutes. Then slowly and gently stretch, holding each stretch
for 30 seconds.
• Cool down and stretch. Stretching at the end of practice is too often neglected because of busy
schedules. Stretching can help reduce muscle soreness and keep muscles long and flexible. Be sure to
stretch after each training practice to reduce your risk for injury.
• Hydrate. Even mild levels of dehydration can hurt athletic performance. If you have not had enough
fluids, your body will not be able to effectively cool itself through sweat and evaporation. A general
recommendation is to drink 3 cups of non-caffeinated fluid 2 hours before exercise. Drinking an
additional cup of water or sports drink right before exercise is also helpful. While you are exercising,
break for a cup of water every
Hydrotherapy Pool
20 minutes.
• Nutrition. Start your exercise or
competition with glycogenloaded muscles by eating
carbohydrates for at least
several days before the event.To
replenish energy and delay
fatigue, eat additional
carbohydrates when you
exercise or compete for longer
than one hour. How your body
uses fat for energy depends on
the intensity and duration of
exercise. For example, when you
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rest or exercise at low to moderate intensity, fat is the
primary fuel source. As you increase the intensity of
your exercise your body uses more carbohydrates for
fuel. If your body uses up its glycogen supply and
you continue exercising you will burn fat for energy,
decreasing the intensity of your exercise.
2) Ensure Proper Equipment
Protective equipment is one of the most important
factors in reducing the risk of injury. Players should wear
the protective gear specific to their game. Some of it is
mentioned below
• Helmet
Cardio Gym
• Shoulder pads, hip pads, knee pads
• Thigh guards
• Mouth guard (A keeper strap is required.)
• Athletic supporter
• Shoes (sneakers, rubber cleated shoes. Detachable cleats of a soft-composition)
• If eyeglasses must be worn by a player, they should be of approved construction with non-shattering
glass (safety glass). Contact lenses also can be worn.
3) Prepare for Injuries
• Coaches should be knowledgeable about first aid and be able to administer it for minor injuries, such
as facial cuts, bruises, or minor strains and sprains.
• Be prepared for emergencies. All coaches should have a plan to reach medical personnel for help with
more significant injuries such as concussions, dislocations, contusions, sprains, abrasions, and
fractures.
4) Safe Return to Play
An injured player's symptoms must be completely gone before returning to play. For example:
•
In case of a joint problem, the player must have no pain, no swelling, full range of motion, and
normal strength.
•
In case of concussion, the player must have no symptoms at rest or with exercise, and should be
cleared by the appropriate medical provider.
5) Listen to your body
•
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Avoid the pressure that is now exerted on many young athletes to over train. Listen to your body and
decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury
and help avoid “burn-out.” Learn to recognize early signs of pain and discomfort
Principles of Sports Rehabilitation
Dr. Sadhana Meena, Physiotherapist
Sports Injury Centre
S
ports medicine and rehabilitation is concerned with the wellbeing of the athlete. Preparing an
individual to successfully participate in sports requires expertise from multiple specialities in order
to achieve complete restoration of pre-injury performance of the injured.Physical conditioning is
the key to injury prevention and rehabilitation. Each sports activity imposes demands on the body;
successful rehabilitation programme is constructed on proper muscle strength, endurance, power
development and cardiovascular conditioning.
Principlesgoverning rehabilitation after muscle and tendon injuries, it isimportant to acknowledge the
ability to educate patients oninjury prevention principles as well as the principle PRICE because
protection may play a larger role in an athletic population.Application of ice or cryotherapy is performed
severaltimes a day for a minimum of 48 hours to help limit the amountof bleeding from surrounding
tissue. Compression wraps orbandages may also be used to help minimize the swelling the inflammatory
phase of the healing response isimportant, rest and immobilization of the injured tissue shouldbe
limited and not last longer than 1 to 2 days.
This is based onanother principle of rehabilitation for acute injuries that involvesearly mobilization to
restore tensile strength of the injured tissue.Soft tissue will respond to the physical demands placed onit;
it will remodel or realign along the lines of tensile force, andearly motion that applies stress serves as a
physical stimulus to aid in the formation and maintenance of collagen. Prolongedimmobilization and
deprivation of stress lead to actual loss ofcollagen fibers.In other words, controlled mobilization is
better than immobilization to restore the tensile properties of thetissue. Additionally, immobilization
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may cause contractures,muscle atrophy, and disorganization of
collagen fibers. Theexception to this principle is complete
muscle or tendon rupture,for which longer immobilization is
necessary. In this case,conservative treatment involves
immobilization with only controlledpassive ROM for several
weeks to allow the tissue to heal with proper alignment.
Early mobilization after injury is implemented through painfree ROM exercises and should be initiated shortly after the
initial inflammatory response phase. Both passive and active
exercises that apply a longitudinal strain to the injured structure
will help the tissueto accommodate to the new stress. When
rehabilitating an acute injury, it is also important to prescribe
exercisesinitially at a low load to stress the collagen fiberswithout overloading them and progressively
increase the demands placed on the tissue. As the pain and swelling subside and the healingprocess
continues, the patient can progress through ROM, flexibility, and strengthening exercises in a controlled
fashion. The patient should begin with active ROM in the pain-free range. If mobilityremains limited in
the subacute stages of healing, heat modalities may be considered in combination with manual
techniques to increase ROM and soft tissue mobility. Otherwise, isometric exercises can be prescribed
for initial strengthening and should progress to isotonic strengthening.
Balance activities can also be incorporated into the rehabilitation program sinceloss of proprioception
often occurs with injury. Throughout the rehabilitation process, general conditioning exercises that do
not aggravate the condition may be performed to maintain cardiovascular endurance, flexibility, and
strength of the surrounding joints. While increasing tensile loading throughoutthe rehabilitation
program, the clinician should continuously monitor for pain with progression of activity. Pain may
indicate loading and alert the clinician to alter the rehabilitation program.
The final phase of rehabilitation is return to functional participation in occupational, recreational, or
athletic activities. This phase should include a gradual progression of functional or sport-specific
training activities over a period of several weeks. As the level of functional activity progresses in
difficulty, the clinician continues to monitor for pain or weakness as a sign to return to an easier level of
physical activity. This is important because returning the patient to functional or athletic activitytoo soon
may predispose the athlete to reinjury.
The principles of rehabilitation for acute injuries include application of the soft tissue healing stages,
early mobilization after injury, and progressive loading of the tissue for return to function. Goals after an
injury are to (1) control pain and oedema;(2) restore normal ROM and flexibility; (3) re-establishnormal
strength, endurance, and neuromuscular control; and (4) achieve preinjury function and activity.
Management of tendinosis includes eccentric exercises and stretching. Other factors such as
modifications in training routines and the use of tape, braces, or orthotics may also decrease pain and
improve function. Strategies to prevent muscle-tendon injuries include flexibility and proper strength
conditioning. Successful completion of the rehabilitation process is important because inappropriate
management of injury may lead toworsening of the pathology or may place the individual at risk for
future injury. The health and safety of the athlete must be number one priority in any practice or
competitive situation. For complete rehabilitation the whole body must be the focus of rehabilitation
programme, not just the injured area.
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Sports Injuries
Dr. Vineet Jain
Associate Professor, Sports Injury Centre
S
ports injuries rank second highest in terms of cause of injury, after home and leisure accidents;
and rank third in terms of severity, after traffic accidents and violence. In recent years, more and
more athletes are undertaking intense training at younger ages or participating in multiple sports
in one season, thereby exposing themselves to more opportunities for acute injury and increasing their
risk for overuse injuries. Injuries are often considered an inevitable part of sports. However, like other
injuries, sports injuries are potentially avoidable.
Timely therapy intervention can have dramatic effects on recovery rate of sports injuries. Sports injuries
can be acute or chronic ongoing 'niggles' that just won't go away. They can be debilitating & recovery
times can be lengthy & frustrating. Injuries can lead to long-term weakness in an area & may increase the
chance of re-injury, even during less strenuous activity if neglected. Some most common sports injuries
which are suffered by all sports person and it needs professional attention and diagnosed in order to heal
properly for healthy body of a Sports person. Most of these injuries need a Sports Medicine Specialist
and physiotherapist for proper diagnosis, treatment and rehabilitation.
FOLLOWING IS THE LIST OF MOST COMMON SPORTS INJURIES
Abrasions: Injuries that result from a fall on a hard surface that causes outer layers of skin to rub off.
Delayed-Onset Muscle Soreness: Muscle pain, stiffness or soreness that occurs 24-48 hours after
unaccustomed or particularly intense exercise.
Hamstring Pull, Tear, or Strain: Hamstring injuries are common among runners. The hamstring
muscles run down the back of the leg from the pelvis to the lower leg bones, and an injury can range from
minor strains to total rupture of the muscle. Anterior Cruciate Ligament(ACL) Injuries : ACL partial
or complete tears can occur when an athlete changes direction rapidly, twists without moving the feet,
slows down abruptly, or misses a landing from a jump.
Blisters : A fluid-filled sack on the surface of the skin that commonly occurs on the hands, or the feet.
Achilles Tendon Rupture: The exact cause of rupture of the Achilles tendon is not known. As with
Achilles tendonitis, tight or weak calf muscles may contribute to the potential for a rupture. Ankle
Sprains: The most common of all ankle injuries, an ankle sprain occurs when there is a stretching and
tearing of ligaments surrounding the ankle joint.
Concussion: A concussion is typically caused by a severe head trauma where the brain moves violently
within the skull so that brain cells all fire at once, much like a seizure.
Knee Pain: Knee pain is extremely common in athletes. In order to treat the cause of the pain, it is
important to have an evaluation and proper diagnosis. Patellofemoral arthritis, meniscal tears,
infrapatellar bursitis or ligament rupture are common causes.
Muscle Cramps: A cramp is a sudden, tight and intense pain caused by a muscle locked in spasm. You
can also recognize a muscle cramp as an involuntary and forcibly contracted muscle that does not relax.
Overtraining Syndrome: Overtraining syndrome frequently occurs in athletes who are training for
competition or a specific event and train beyond the body's ability to recover.
Plantar Fasciitis : Plantar fasciitis is the most common cause of pain on the bottom of the heel and
usually defined by pain during the first steps of the morning.
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10
Shin Splints: Shin Splints describes a variety of generalized pain that occurs in the front of the lower leg
along the tibia (shin bone). Shin Splints are considered a cumulative stress injury.
Shoulder Tendinitis, Bursitis, and Impingement Syndrome: These conditions similar and often
occur together. If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become
squeezed between the head of the humerus and the acromion. It usually results in pain or weakness
during overhead abduction of shoulder.
Sprains: These are acute injuries that vary in severity but usually result in pain, swelling, bruising, and
loss of the ability to move and use the joint.
Stress Fracture: Stress fractures are often the result of overuse or repeated impacts on a hard surface. It
usually occurs in leg and in foot. Xrays are normal but bone scans reveal increased uptake.
Tendinitis: Tendonitis is a common sports injury that often occurs from overuse. Tendinitis can cause
deep, nagging pain that is caused by inflammation of tendons. Treating tendinitis consists of rest,
medication, physical therapy or changes to equipment or technique. Tennis Elbow (Lateral
Epicondylitis): It is among the commonest cause of elbow pain. It is considered a cumulative trauma
injury that occurs over time from repeated use of the muscles of the arm and forearm that lead to small
tears of the tendons. Iliotibial (IT) Band Friction Syndrome : Knee pain that is generally felt on the
outside (lateral) aspect of the knee or lower thigh often indicates Iliotibial (IT) Band Friction Syndrome.
It is imperative that a proper diagnosis, treatment and rehabilitation is done by a team of trained
orthopaedic surgeons, sports medicine specialist and physiotherapist for faster recovery and sending
sportsperson back to field.
It is also important to take care of psychological aspect of injuries as most sportsperson are highly
apprehensive about the time for recovery and whether they will be fit for next competition.
More important than treatment, prevention of injuries is most important. It is important to assess
strength and weakness in a sports person, according to his body composition advising about his place in
team sports, precautions for injury prevention, conditioning of body before competition. Proper
nutrition is another important aspect, especially in India due to various religious beliefs and eating habits.
Sportsperson need to be made aware about various common drugs to be avoided, telling their treating
doctor about the need for medication not banned by WADA for their particular sport. All these are
important part of management of Sports injuries.
50
Rashmi Singh
(Rashmi Singh is a civil servant with more than two decades of distinguished track record in the government having served in various
capacities such as Director, Welfare in New Delhi Municipal Council ( 1999-2004), Director, Mission Convergence, Delhi
Government ( 2008-2011), Executive Director , National Mission for Empowerment of Women, Ministry of Women and Child,
Government of India ( 2011-August,2014) . She is the Convener of a National Forum for Action on Convergence, which brings
civil society, experts and government on a common platform on the issue of social inclusion and gender justice. She has also pioneered a
rural development initiative called 'Chalo Gaon Ki Ore' spearheading voluntary action for social change. Ms. Singh has been honored
nationally and internationally for her work, some of the notable awards and recognitions she has received are, the Commonwealth
Association for Public Administration & Management ( CAPAM) Innovation awards for Stree Shakti ( 2006); Mission
Convergence ( 2010); Leadership Award for Internationals from University of Minnesota, USA ( 2011); Women of Excellence
Award from FICCI-FLO; Devi AhilyaBaiHolkar Award, Stree-Shakti award by the Ministry of WCD, Govt of India (
2010) and the DayawatiModiStree Shakti Samman, 2013.
Medical Fraternity and Social Responsibility
As a travel to different parts of India visiting the rural areas and the urban slums, I am struck more and more by the
extent to which health is a predominant determinant which accentuates the vulnerable conditions of the poor
community . It is ironical that the large section of society which has to rely on its physical strength and endurance
for making its living is the one which lives in poor health due to poor nutrition, insanitary conditions of their
habitat, lack of access to good quality water, open defecation etc. The problem stems on the one hand due to lack
of awareness, and affordability as also the failure of our public health systems.
I feel that the medical fraternity can collectively play a very important role in bridging the access gap and improve
the conditions of those who are in the vicious cycle of poverty and debt trap due to ill health of self and others
who are dependent on them. However what is needed is to question how true we are to this noble profession. We
often hear very sad and unfortunate incidents of doctors selling their souls to make money, with scant regard to
the impact their commercialization and business instinct would make on the hapless family which has no option
but to trust the doctor who they think would be their savior
Apart from their own codes of conduct I feel that the medical fraternity should reach out more to the poor
community by sparing some time off their busy schedule to volunteer services for health and wellness camps in
association with genuine non-profit organizations. In my efforts to reach out to the poor community at the
grassroots through voluntary action, I have come across doctors who are ready to support the cause of serving
the underprivileged in many different ways. I am also appreciative of the willingness of the Director, SIC and his
team to extend a supportive hand to strengthen such practices which can change lives of the underprivileged
especially women and children living in not only in urban areas but also in remote villages.
I appeal to others in the medical fraternity to similarly reach out since a little effort on our part can wipe many
tears and spread sunshine around.
Email. [email protected]
Facebook Page :- www.facebook.com/rashmi.singh.9619934
Blog : rashmisinghstreeshakti.blogspot.in
www.nfconvergence.org, www.nanakindia.org
Facebook Page: ChaloGaon Ki Ore / Gaon Ki Selfie
51
Scientific Programme
Live surgery day one-Knee
(June 27, 2015)
08:00 am
to
11:00 am
Name of the Surgery
Surgeon
Chairperson
Moderators
S1
SB ACL Reconstruction
Dr.Ravi Gupta
Dr. RC ARYA
Dr. Rajeev Gupta
Dr. LalitMaini
S2
SB ACL Reconstruction – BTB
Dr. Pushpinder Singh Bajaj
Dr. Prateek Gupta
Dr. KD Tripathi
Dr. LalitMaini
S3
All Inside ACL Reconstruction
With Meniscal repair
Dr. Mark Fergusson
Dr. MandeepDhillon
Dr. RajuEaswaran
Dr. Devender Singh
S4
Double Bundle ACL
Dr. Deepak Chaudhary /
Dr. Deepak Joshi
Dr. VB Bhasin
Dr. Devender Singh
Dr. Roshan wade
Anchor
Panelists
11:00 am
to
11:30 pm
Panel Discussion 1
Dr. RajuEaswaran
ACL
Panelists
Dr. Ashok Rajgopal
Dr. Louis
Dr. VB Bhasin
Dr. Debashish Chatterji
Dr. Mandeep Dhillon
Dr. J Maheshwari
11:00 pm
to
01:30 pm
Name of the Surgery
Surgeon
Chairperson
Moderators
S5
ACL Primary Repair
Dr. Mark Ferguson
Dr Roshan wade
Dr. HL Nag
Dr. Ravi Gupta
S6
ACL pin point
Dr.Luigo
Dr. Ashish Devgan
Dr. Atul Mishra
Dr. AttiqueVasudev
S7
ALL Repair
Dr. Luigio
Dr. J Maheshwari
Dr. KD Tripathi
Dr. Roshan wade
01:30 pm
To
02:30 pm
LUNCH
02:30 am
to
05:00 am
Name of the Surgery
Surgeon
Chairperson
Moderators
S8
MCL Repair with Meniscal Repair
Dr. SachinTapasvi
Dr. J Maheshwari
Dr. KD Tripathi
Dr. Roshan wade
S9
PLC with PCL Repair
Dr. Dinshaw
Dr. Kanchan
Bhattacharya
Dr. Amite Pankaj
Dr.KDTripathi
S10
Cartilage Defect
Dr. Clement Joseph
Dr. KalpeshTrivedi
Dr.AttiqueVasudev
Dr. Clement Joseph
152
Live surgery day one-Knee
(June 27, 2015)
Panelists
05:00 pm
to
05:30 pm
Panelists
Dr. Mark Fergusson
Dr. Clement Joseph
Dr. HL Nag
Dr. KalpeshTrivedi
Dr. IPS Oberoi
Dr. DinshawPardiwala
Panel Discussion 2
PCL
Anchor-Dr. Amite Pankaj
05:30 pm
to
07:30 pm
Name of the Surgery
Surgeon
Chairperson
Moderators
S11
MPFL
Dr. Luigio
Dr. Debashish
Chatterjee
Dr. Clement Joseph
Dr. Vinod Kumar
S12
ACL with PCL
Dr. Deepak Chaudhary/
Dr Deepak Joshi
Dr. VB Bhasin
Dr. Raju Easwaran
Dr. Nagaraj Shetty
S13
All Inside PCL
Dr. AttiqueVasdev
Dr. Nagaraj Shetty
Dr. Amite Pankaj
Dr. Dhananjay Gupta
07:30 pm
to
08:00 pm
INAUGURATION
08:00 pm
BANQUET DINNER
53
10
Live surgery day 2-Shoulder
(June 28, 2015)
08:00 am
to
12:00 am
Name of the Surgery
Surgeon
Chairperson
Moderators
S1
Biceps Tenodesis
Dr. Mark Fergusson
DrMandeepDhillon
Dr.RajuEaswaran
ShekarSrivastav
S2
SLAP Repair
Dr. Sanjay Desai
Dr Kanchan
Bhattacharya
Dr. Prateek Gupta
Dr. LalitMaini
S3
AC Joint
Dr. Paul Sethi
Dr. H.L. Nag
Dr. Vinod Kumar
Dr. Shasank Mishra
S4
Anterior Instability
Dr. IPS Oberoi
Dr. RamakantAgarwal
Dr. Ramakant
Agarwal
Dr. Amite Pankaj
S5
Arthroscopic Latarjet
Dr. Ashish Babulkar
Dr. Roshan Wade
Dr. Ashish Devgan
Dr. Shashank Mishra
12:00 am
to
12:30 pm
PANEL DISCUSSION
Anchor
Panelists
Dr Shekhar Shrivastav
Dr. Paul Sethi
Dr. Ashish Devagan
Dr. Dr Kanchan Bhattacharya
Dr. Jitender Maheshwari
Dr. Sanjay Garude
Dr. Prateek Gupta
Anterior Instability
12:30 am
to
1:30 pm
LUNCH
01:30 am
to
05:00 am
Name of the Surgery
Surgeon
Chairperson
Moderators
S6
RC Repair Single Row
Dr. Dinshaw
Dr. Maheshwari
Dr. DebashisChatterjee
Dr. Shashank Mishra
S7
Reverse Shoulder
Dr. Sanjay Desai
Dr Debashish Chatterji
Dr. Raghuveer Reddy
Dr. Vinod Kumar
S8
RC Repair Double Row
Dr. Mark Ferguson
Dr. Maheshwari
Dr. Prateekgupta
S9
RC Repair Double Row
Dr. Sanjay Garude
Dr.Prateek Gupta
Dr. HL Nag
Dr. Ashish Devagan
Dr. Ramakant Aggarwal
S10
Rotator Cuff Repair
Dr.Paul Sethi
Dr. Vinod Kumar
12:00 am
to
12:30 pm
PANEL DISCUSSION
Rotator Cuff
05:30 pm
to
6:00 pm
Dr. NagarajS hetty
Dr. Amite pankaj
Anchor
Panelists
Dr. Shashank Mishra
Dr. Mark Fergusson
Dr. Jitender Maheshwari
Dr. Ashish Babulkar
Dr. Dinshaw Pardiwala
Dr. Sanjay Desai
Dr. Roshan Wade
VALEDICTORY FUNCTION
Profile of Faculty of DAC-2015
Dr. Mark Ferguson
Principle Surgeon and
Sports Medicine Fellowship Director
The Centre for Sports Medicine & Orthopaedics
Johannesburg, South Africa
Dr Ferguson obtained his medical degree from The University of Stellenbosch and
completed his orthopaedic residency programme at the University of the
Witwatersrand. Thereafter he travelled extensively to various Sports Clinics around
the world before opening The Centre for Sports Medicine & Orthopaedics in
Rosebank, Johannesburg.
At present he is the Principle surgeon and the sports medicine fellowship director at the Centre. His main
interest is in arthroscopic reconstruction of the knee and shoulder and sports traumatology.
DR. LUIGI ADRIANO Pederzini
Director, Department of Arthoscopic Surgery & Traumatology,
New Hospital of Sassuolo, Italy
He was graduated in Medicine and Surgery at the University of Modena in 198. He
has been Trained at various centres abroad like University of London Ontario (Dr.
Roth) in 1987, University of St. Etienne (Prof. Bousquet ) in 1987, University of
Utah (Dr. Rosenberg ) in 1991, University of Philadelphia ( Dr, Ostermann ) in
1991, University of Richmond (Dr. Caspari , Dr, Whipple ) in 1991, University of
Pittsburgh ( Dr. Fu , Dr. Harner ) 1994-1996, Help Orthopaedic Hospital at the
State of the Republic of S. Marino 1988-1998.
He has been a Speaker and moderator at the Congresses and Courses of the Italian Society of
Arthroscopy in the last 10 years. He is the Member of the European Society of Knee Surgery and
Arthroscopy since 1990 ( ESSKA ), Member of the International Society for Arthroscopy Knee Surgery
and Sports Medicine since 1994 (ISAKOS ). He was SIA President 2005-2007. He is the Member of the
Board of Directors of the Italian Society of Arthroscopy in the last 4 years. He has been the Organizer
and Chairman of the different Conferences.He is the author of 80 scientific papers published (15 in
international journals ) and a book (arthroscopy of wrist). From 1998 to 2005 to the present he is the
Head of Arthroscopic Surgery Center Nursing Home Villa Fiorita in Sassuolo (Modena). He was Head
of Department of Orthopaedics and Arthroscopic Surgery New Hospital in Sassuolo (MO) since 2005.
He is the ISAKOS committee member for Upper Limb Arthroscopy. He is the Member of the American
Academy of Surgeons since 2006.
Current interests: ligament reconstructions, Arthroscopy of the shoulder, elbow , wrist.
Reconstructive surgery of the cartilage.
Dr. Paul M Sethi, MD
ONS Sports & Shoulder Service,
Clinical Instructor of Orthopaedic Surgery
Yale University School of Medicine, USA
Paul Sethi, MD is a board-certified orthopedic surgeon who specializes in sports
medicine, the shoulder and elbow. He is a leading research physician who speaks at
academic and instructional medical conferences in the US and abroad. His research
on surgical advances for the shoulder, elbow and knee is regularly published in
leading medical journals including the Journal for Shoulder and Elbow Surgery,
Arthroscopy, and the Journal of American Academy for Orthopaedic Surgery. He
also collaborates with outside companies for education and research purposes and to develop medical
procedures on the shoulder, elbow and knee. He is a member of the prestigious American Shoulder and
Elbow Society and American Academy of Orthopedic Surgeons. He is President of the ONS
Foundation for Clinical Research and Education.
55
Prof (Dr) Ravi Gupta,
MBBS, MS, DNB,
MNAMS, FIMSA
Head, Orthopaedics &
Incharge Sports Injury Clinic
GMCH, Chandigarh
He has obtained Advanced Professional Trainings in various countries
like Austria, Australia, USA etc.
He has Treated a number of national and International Sports Persons like Abdul Razzaque,
(Pakistan Cricketer) 1997, Ashley Giles (English Cricketer) 2001 etc.
He is the President of Indian Academy of Arthroscopy and Sports Medicine,
Chairman of Hand Section Indian Orthopedics Association. He has presented 305 guest lectures/
research papers at national and international level. He has been Invited as Columnists (Health and
Fitness), The Tribune Chandigarh. He has Published 96 papers/ articles and Published, 4 chapters in
books
He is the Working Editor of Journal Of Orthopaedic Surgery (Hongkong), Editor in Chief: Journal of
Arthroscopy and Joint Diseases (Elsevier), Editor (Sports Medicine and Arthroscopy), Assistant Editor
Indian Journal of Orthopaedics, Member Editorial Board, BMJ Case Reports, Ex. Editor: Punjab
Journal of Orthopaedics
He has Invented New Surgical Techniques Published in International Journals:
• Reconstruction of DRUJ Wrist:
J Bone Joint Surg (Br)
• Reconstruction of Anterior Cruciate Ligament Knee
Current Orthop Practice
• Repair of biceps tendon at elbow
Indian J Orthopaedics
Dinshaw Pardiwala
Head – Centre for Sports Medicine, &
Director - Arthroscopy & Shoulder Service
Kokilaben Dhirubhai Ambani Hosptal, Mumbai, India.
He is an ISAKOS committee member, and is on the editorial board of Arthroscopy,
and American Journal of Sports Medicine. He is the section editor (arthroscopy) for
the APKASS journal (Asia Pacific Knee, Arthroscopy, and Sports Medicine Society)
and associate editor of JAJS (Journal of Arthroscopy & Joint Surgery). He is the team physician for many
Indian Olympic and national sports teams including the BCCI. He is actively involved in research and has
numerous international publications and presentations. His work in arthroscopy has been internationally
recognized and he is the recipient of many international and national academic awards including the
ISAKOS John Joyce Award 2009.
56
Dr Sachin Tapasvi
MBBS and M.S. (Ortho)
D.N.B.(Orth)
M.N.A.M.S
A.F.A.O.A.
Dr Sachin Tapasvi, at 42, is one of the leading joint replacement surgeons practicing
in Pune, boasting of several fellowships and experience garnered internationally as
well as in India. He completed his MBBS and M.S. (Ortho) from B.J. Medical College, Pune. He further
honed his skills after being selected as an Asia Pacific Fellow at The Queen Elizabeth Hospital, Adelaide,
Australia from January 1998. Here, Dr Tapasvi was entrusted with the Adult Reconstruction Surgery
services comprising Arthroscopy and Joint Replacement. His talent was recognised and lauded with an
appointment as the Clinical Tutor to The University of Adelaide. After returning to India, he began
working as a consultant in arthritis, sports medicine, arthroscopy and joint replacement with some of the
premier hospitals in Pune - Jehangir Apollo Hospitals and Deenanath Mangeshkar Hospitals and Oyster
and Pearl Hospitals. Dr Tapasvi now conducts specialty outpatients with a combined patient load of
about 80 patients per day. Dr Tapasvi routinely performs complex surgeries and operates daily at
hospitals conducting supra major and major surgeries with Total Knee Replacement (TKR), Revision
TKR, Total Hip Replacement (THR), revision THR, arthroscopic knee and shoulder reconstructions.
His initiative called the Pune Knee Course - an annual educational program since 2011, covering
everything in knee arthroscopy, is very well received every year.
Dr Pushpinder Singh Bajaj
M.S.(ORTHO),D.N.B.(ORTHO),
M.I.M.S.A.,M.N.A.M.S., F.I.A.S.(U.K.),
MSC.-ORTHO(U.K.),
DIPLOMA SPORTS MEDICINE(U.K.)
He is the consultant Orthopaedic surgeon, SPECIALIST IN ARTHROSCOPIC
SURGERY , SPORTS INJURIES AND JOINT REPLACEMENTS.
He is in Private practice mainly concentrating on Sports Injuries , Arthroscopic Surgery and Joint
Replacement Surgery . Have treated many prominent players in Tennis,Cricket & Golf. Have attended
various conferences national and International . Organised various National & Regional Conferences &
Workshops in Arthroscopy & Sports Medicine
57
Dr. I P S Oberoi
Director and Head of Joint Replacement & Arthroscopy unit
Artemis Health Institute.
He is also the Secretary of Asian Arthroscopy congress, Convener of arthroscopy
learning center and Member of Indian arthroscopy society. He has been trained in
joint replacement and adult reconstructive trauma surgery from Klinik und
Poliklinik fur Unfall-,Hand & Wiederherstellungschirurgie,Universitatsklinikum,
Munster Germany. He has also been trained in knee reconstructive surgery ,
Henriettenstiftung, Hannover, Germany. He has gained Joint replacement training
at Nuffield hospital, Exeter, U.K and Joint Replacement unit, Queen Elizabeth hospital, Exeter, U.K. He
has been trained in knee arthroscopy and reconstruction, Sporthopaedicum, Straubing, Germany and
Rosebank clinic, Johannesburg, South Africa. Also Trained in shoulder surgery , center Hospitalier, St
Gregoire, Rhein, France and Cape shoulder clinic, Cape Town, South Africa.
Dr. Sanjay Garude
MS Orth, DNB Orth;
MCh Orth (Liverpool, UK);
D'Orth; FCPS Ortho.
Arthroscopy & Sports Medicine.
Shoulder and Knee Clinic.
Consultant - Lilavati, Saifee & Breach Candy Hospital.
He has Undergone Arthoscopy training at USA, Australia, France and UK, he is
the Faculty – Indian Arthroscopy Society. Dedicated arthroscopy surgeon for over 15 years.
Dr Attique Vasdev
MBBS , MS (Ortho)
Director Knee Unit, Medanta Hospital
Dr Attique Vasdev after completing his PG joined Holy Family Hospital as senior resident & later shifted
to Govt Medical College Chandigarh. He then moved to Kasturba Medical College Manipal & worked as
Assistant Professor in Dept. of Orthopaedics till 2002 before joining Sir Ganga Ram Hospital as
Orthopaedic Consultant. He is presently working as Director Knee Unit in Medanta Hospital since its
inception in 2009. He has undergone Trauma fellowship In Developing & Organizing Trauma system
from Israel & done his fellowship in Joint replacement from Germany. His special interest includes Knee
replacement, Sports Injuries and Ligament reconstruction around the knee. He has to his credit many
International & National Papers. He has also contributed to Chapters in many books on Joint
Replacements & Sports Injuries.
58
Dr. Deepak Chaudhary,
Director & Consultant, Sports Injury Centre,
Safdarjung Hospital, New Delhi
Dr Deepak Chaudhary is an eminent Orthopaedic Surgeon, he has rich professional
experience of more than 22 years in the Super Specialty of Arthroscopy & Sports
related Injuries. Presently heading the Sports Injury Centre as its founder Director.
Under his leadership the centre has evolved as a centre of excellence on both the
clinical and academic fronts. On the Clinical front the centre has performed more than 7000 complex
and technically demanding surgeries over the last 5 years. On the academic front, the centre is the first to
start courses like MD Sports medicine and FNBE in Sports Medicine. The centre has also hosted several
various National and international conferences including various ISAKOS approved cadaveric courses.
Recently the centre has started Online registrations for OPD services- again a first of its kind in a
government setup.
He is the Life Member of the national and international orthopedic associations. He has to his credit
various national and international publications.
Besides, he has been a National Level Badminton Player and winner of Delhi State Championship & All
India Inter Medical Badminton Championship. Presently he is participating in various national and
international full and half marathon.
Dr. Deepak Joshi
Specialist, Sports Injury Centre,
Safdarjang Hospital, New Delhi
Dr Deepak Joshi is working as a Specialist at the prestigious first Sports Injury
Centre of the country at VMMC & Safdarjang Hospital, New Delhi. He has vast
experience of more than 16 years in the field of Arthroscopy (procedures of Knee,
shoulder, hip, elbow and ankle) and Arthroplasty. He has been the founder member
of this center which has been a landmark center in this field. On the academic front,
he has been a gold medalist at UG level and has nearly 20 publications to his credit. He has been a faculty
member in many national conferences and cadaveric courses abroad. He has also been organizing
Secretary of number of cadaveric courses organized by center and also the first two editions of Delhi
Arthroscopy Course. Along with Dr. Chaudhary and leading practitioners in the field, he has been
instrumental in starting the Indian Academy of Arthroscopy learning and Sports Medicine with the sole
aim of training the interested doctors in the field of Arthroscopy. He has also been a coordinator in
holding ISAKOS approved fellowship training program at the center, which is the only center approved
in northern India. On clinical front the centre has performed more than 7000 complex procedures in last
five years.
59
AC Joint Dislocation
Dr. Mukul Mahindra, Fellow, Sports Injury Centre
Dr. Ankit Goyal, Assistant Professor, Sports Injury Centre
Acromio-clavicular (AC) joint dislocations are common injuries of the shoulder girdle in sportsmen comprising
around 3-12% of all shoulder injuries. The injuries are classified by Rockwood classification. Low-grade injuries
(types I and II) should be initially managed non-surgically. Surgical treatment is typically reserved for high-grade
lesions (types IV through VI) and might be beneficial in some type III lesions in high demand patients. Due to
recently published biomechanical data, there is a current trend towards an anatomic reconstruction of the coracoclavicular (CC) ligaments. Anatomic reconstructions attempt to reproduce the CC ligaments with either allograft
or autograft tissue.
Arthroscopic techniques involve anatomically reconstructing a disrupted acromioclavicular joint by replacing the
coracoclavicular ligaments with sutures. Ideally, the patient's own CC ligaments and periosteal sleeve, including
the acromioclavicular joint capsule, will subsequently heal when held in a reduced position. Since these techniques
typically use tunnels through the coracoid and/or the distal clavicle for suture button or graft fixation,
complications like fractures of the coracoid process or the clavicle have been described. Moreover, anatomic
reconstructive techniques have introduced a new complication profile including migration of suture buttons and
rupture of the suture threads. In 2008, Walz et al. have reported on the biomechanical strength of an anatomic
suture button repair, which showed comparable stability to the native ligaments. Using an anatomic double
TightRope(TR) suture button technique, Scheibel et al. have reported on good to excellent early clinical results
(mean follow-up: 26.5 months) in 37 patients without any coracoid fracture or early loss of reduction (within 6
weeks).Recently, Beiztal et al compared single clavicular coracoid tunnel with double clavicular coracoid tunnel
evaluating the TR system and found that there was no significant difference between single and double tunnel
techniques. Anyhow, more research is needed in the field to firmly establish the ideal technique for AC joint
reconstruction. The arthroscopic procedures using the TR system are a reproducible and easy technique which
give reasonably good clinical results but may require improvement in biomechanics to prevent loss of reduction
due to wire breakage or button migration. Increase in size/ change in contour of button or additional
strengthening with autogenous ligaments may be suggested.
References
1. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope
devices: a biomechanical study. Am J Sports Med.2008;36:2398–406.
2. Salzmann GM, Walz L, Schoettle PB, Imhoff AB. Arthroscopic anatomical reconstruction of the acromioclavicular joint. ActaOrthop Belg.
2008;74:397–400.
3. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am.
1972;54A:1187–94.
4. Beitzel K, Obopilwe E, Chowaniec DM, Niver GE, Nowak MD, Hanypsiak BT, et al. Biomechanical comparison of arthroscopic repairs for
acromioclavicular joint instability: suture button systems without biological augmentation. Am J Sports Med. 2011;39:2218–25.
5. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB. Arthroscopically assisted 2-bundle anatomical reduction of acute
acromioclavicular joint separations. Am J Sports Med. 2010;38:1179–87.
6. Scheibel M, Droschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J
Sports Med. 2011;39:1507–16.
60
Anterior Shoulder Instability
Dr. Himanshu Bhargava, Senior Resident, Sports Injury Centre
Dr. Vineet Jain, Associate Professor, Sports Injury Centre
Glenohumeral joint stability requires an intricate combination of both static and dynamic stabilizers. Anterior
glenohumeral instability has been estimated to have an incidence of 11.2 cases per 100,000 persons and typically
follows a traumatic injury. For patients with recurrent instability, generally, surgical stabilization is warranted.
Currently chronic anterior shoulder instability in young adults is treated surgically via arthroscopic approach
aiming to restore the damage in the glenoid labrum, i.e. by repairing the Bankart lesion. With recent improvements
in arthroscopic stabilization techniques, including suture anchors, a review of the current literature indicates that
it is possible to arthroscopically mirror the principles of open anterior shoulder stabilization in select patients,
1-4
therefore, making it possible to obtain similar outcomes.
Metallic suture anchors (2.8mm) have been traditionally used for Arthroscopic Bankart repair with great success.
Recently knotless suture anchors are designed for arthroscopic glenohumeral joint instability and SLAP repair.
These anchors provide the ability to independently pass the suture through a desired amount of tissue prior to
anchor implantation. This feature allows for the proper capture of the amount of capsule or labrum required for
the pathology being treated. These unique, two piece anchors allow for proper visualization and adjustment of
tissue tension prior to final implant installation.
Bankart Repair
Remplissage
Sometimes anterior instability is associated with a large Hill Sachs lesion and 'engaging' the anterior glenoid with
little overhead movement (i.e. dislocating very easily due to the large Hill-Sachs lesion, as well as the Bankart
lesion). In these situations a Bankart repair alone may not be sufficient. In such cases, Remplissage is preformed.
The procedure was described in 2007 by Wolf et al as an adjunct to the arthroscopic anteriorstabilisation
procedure of the shoulder in order to address a large engaging Hill-Sach's defect. The Remplissage technique has
been reported to be effective in reducing the incidence of recurrent anterior shoulder instability, when used along
61
with arthroscopic Bankart repair. In this technique a triple-loaded large rotator cuff anchor is inserted into the
Hill-Sach's defect through the posterior portal. Sutures are passed through the infraspinatus tendon and the
posterior capsule, which are then tied down with a 'parachute technique', hence successfully filling the defect on
the humeral head.
In cases of failed Bankart repair or significant glenoid/bipolar bone loss, latarjet has been found to be an effective
procedure. The procedure involves transfer of the coracoid with it's attached muscles to the deficient area over the
front of the glenoid. This replaces the missing bone and the transferred muscle also acts as an additional muscular
strut preventing further dislocations. The procedure has a high success rate (recurrence rate of less than 1%4) and
this is due to the 'triple effect' described by Patte. These are: 1) increase or restore the glenoid contact surface area;
2) the conjoint tendon stabilises the joint when the arm is abducted and externally rotated, by reinforcing the
inferior subscapularis and anteroinferior capsule; 3) repair of the capsule. This triple effect is why the Latarjet is
such a successful procedure.
Latarjet
References
62
1.
Kim SH, Ha KI, Kim SH. Bankart repair in traumatic anterior shoulder instability: Open versus arthroscopic technique. Arthrsoscopy.
2002 Sep;18(7):755-63.
2.
Bottoni LCR, Simth EL, Berkowitz MMJ, et al. Arthroscopic versus open shoulder stabilization for recurrent anterior instability. Am J
Sports Med. 2006 Nov;34(11):1730-7.
3.
Owens BD, DeBerardino TM, Nelson BJ, et al. Long-term follow-up of acute arthroscopic Bankart repair for initial anterior shoulder
dislocations in young adults. Am J Sports Med. 2009 Apr;37(4):669-73.
4.
Burkhart SS, DeBeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy.
2002 May-Jun;18(5):488-91
DBACL
Dr. Darsh Goyal, Senior Resident, Sports Injury Centre
Dr. Vineet Jain, Associate Professor, Sports Injury Centre
Surgical repair of the anterior cruciate ligament is a fairly common necessity in knee injuries, usually with good to
excellent outcomes. However a successful repair and return to activities for a subpopulation of patients, 10% to
30%, remain elusive. Additionally, some athletes have arthritic changes, even with ligament repair.
Although the ACL is referred to as one ligament, it consists of two functional bundles. These two bundles are
named for the place where they attach on the tibia. There is an anteromedial (AM) bundle, which inserts more
anterior (Towards the front) and medial (towards the inside) of the tibia. The posterolateral (PL) bundle inserts
most posterior (towards the back) and lateral (towards the outside) of the tibia. The AM bundle is tight when the
knee is bent and provides stability in the forward (anterior) direction. The PL bundle is loose when the knee is
bent, and allows for rotation of the knee. When the knee is straight the two bundles are parallel to each other, but
when the knee is bent the two bundles cross each other. On the femur, there are two ridges that outline the
insertion of the ACL to the bone. There is one ridge that borders the top of the ACL (the lateral intercondylar
ridge) and there is one ridge that forms the border between the AM and PL bundles (the lateral bifurcate ridge).
When your ACL is torn off the femur, these two ridges serve as a map to help us to find the location where your
ACL used to attach.
Double bundle ACL reconstruction was proposed to closely restore the normal structure of the ACL. Although
double bundle reconstruction is more effective than single bundle reconstruction for restoring normal knee
kinematics, the operative techniques are various in terms of the fixation angle and device. Moreover, double
bundle reconstruction techniques are technically more demanding and necessitate longer operative times and
more extensive bone loss, thereby potentially rendering revision surgery more difficult. Although a recent metaanalysis study showed that double bundle reconstruction provides better results in terms of anterior stability and
pivot-shift test than single bundle reconstruction, some studies failed to demonstrate significant comparative
advantages of double bundle techniques in terms of clinical outcomes.
There are a few scenarios where it is actually preferred to perform single bundle surgery over double bundle
surgery:
•
The patient has a very small native ACL size, usually less than 14 mm. This can be estimated on MRI, but can
only be confirmed at the time of surgery.
•
The patient is still growing and his or her growth plate is not closed.
•
The patient has severe arthritis of the knee.
•
The patient has multiple knee ligament injuries or a knee dislocation and multiple other ligaments need to be
reconstructed at the same time.
•
The patient has bone that is severely bruised.
•
The patient has a small “notch”. This is the open space in the femur bone where the ACL houses.
63
MCL Injury With Meniscal Injury
Dr. Parth, Senior Resident, Sports Injury Centre
Dr. Pallav Mishra, Assistant Professor, Sports Injury Centre
The medial collateral ligament (MCL) is one of the most commonly injured ligamentous structures of the knee
joint.1 Grade I and II injuries or incomplete tears are treated with non-operative management. Treatment is
directed initially with rest, cryotherapy, compression, and elevation in the acute phase (72 h). The patient is
allowed to bear weight as tolerated depending on their pain level with use of a hinged knee brace to protect the
knee from further valgus stresses. Active range of motion is initiated early to prevent stiffness with concomitant
strengthening exercises. Treatment of grade III or complete isolated MCL tears is more controversial than
treatment of grade I or II injuries. There is evidence to support both non-operative and operative treatment of
these injuries. Initially, operative treatment was advocated primarily due to the poor initial results of non-operative
treatment. Subsequently, however, in comparison studies no subjective or objective differences were found
between surgically and non-surgically managed groups, and the pendulum has swung toward non-operative
management of these isolated injuries. However, in a subset of patients with tibial-sided avulsions or bony
avulsions, acute repair is indicated .1,2
The indications for meniscal repair have remained controversial.3 However; the ideal indication for meniscal
repair is an acute 1 to 2 cm longitudinal peripheral tear that can be repaired in conjunction with anterior cruciate
ligament (ACL) reconstruction in young patients. The reparability of meniscal tears depends on several factors,
such as vascularity, type of tear, chronicity, and size. A longitudinal tear on red-red zone in an acute setting has a
preferable reparability than a radial or a flap tear on white-white zone in a chronic setting. Meniscal repair can be
performed either with an open or arthroscopic technique. Arthroscopic meniscal repair has advantages over open
repair in terms of minimal incision, early recovery, and rehabilitation. Arthroscopic repair techniques can be
divided into 4 categories: inside-out techniques, outside-in techniques, all-inside techniques, and hybrid
techniques that combine multiple techniques. A meniscal tear on mid-third horn or a peripheral capsule area can
be repaired with inside-out technique. Repair of a meniscal tear on anterior horn or an attempt to reduction of
bucket-handle tear can be performed with outside-in technique. All-inside technique can be used in a meniscal tear
on posterior horn.4,5
Partial Meniscectomy is done when tear involves interior 70%. It may be done when athlete wants to resume
activity ASAP. It is done with mobile fragments. It is usually 10-35 minute arthroscopic procedure under regional
or general anesthetic, in which mobile areas removed & edges contoured to “prevent further tears”. Patient is
allowed immediate partial weight bearing.
Conservative Therapy is not an option if knee locked, fragment not reduced. Symptom relief is with RICE,
NSAIDS, and immobilization. Physical therapy focusing on closed chain exercise of quadriceps and hamstrings.
Failure includes recurrent effusion, recurrent locking or pain that interferes with ADLs.
References
64
1.
Petermann J, von Garrel T, Gotzen L. Non-operative treatment of acute medial collateral ligament lesions of the knee joint. Knee Surg
Sports Traumatol Arthrosc. 1993;1(2):93–96. [PubMed]
2.
O'Donoghue DH. Reconstruction for medial instability of the knee. J Bone Joint Surg Am.1973;55(5):941–954. [PubMed]
3.
Binfield PM, Maffulli N, King JB. Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury
1993;24:557-61.
4.
Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate
ligament reconstruction in patients 40 years of age and older. Arthroscopy.2000;16:822–829. [PubMed]
5.
Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear
of the medial meniscus: a prospective comparison study.Arthroscopy. 2011;27:1644–1653. [PubMed]
MPFL
Dr. Utkarsh, Senior Resident, Sports Injury Centre
Dr. Nitin Mehta, Assistant Professor, Sports Injury Centre
Patellofemoral dislocation is a common problem affecting the young and active population. The medial
patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement.
This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of
1-3
rehabilitation
MPFL extends from the medial and superior margin of the patella to the femur, where it is inserted between the
adductor tubercle and the medial epicondyle. It is responsible for 50–60% of the lateral restriction strength of the
patella4,5.
Anatomic Double Bundle Technique for Medial Patellofemoral Ligament (MPFL) Reconstruction replicates the
native shape of the MPFL and provides the best possible stability in both flexion and extension. The Double
Bundle technique also effectively limits rotation throughout the ROM, minimizing postoperative instability. The
technique, if accomplished directly and anatomically, can also provide for more aggressive rehabilitation
protocols and earlier return to activity.
An important determinant of a successful outcome of MPFL reconstruction is the proper position of the
femoral fixation of the graft and our technique incorporates the use of a femoral template to ensure proper
placement of the graft in the femur. This position provides a static fixation point that equalizes the tension across
the graft in flexion and extension, thus minimizing the stresses across the patellofemoral joint.
Reference
1.
Conlan T., Garth W.P., Jr., Lemons J.E. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint
Surg Am. 1993;75:682–693. [PubMed]
2.
Desio S.M., Burks R.T., Bachus K.N. Soft tissue restraints to lateral patellar translation in the human knee.Am J Sports Med.
1998;26:59–65. [PubMed]
3.
Camp C.L., Krych A.J., Dahm D.L., Levy B.A., Stuart M.J. Medial patellofemoral ligament repair for recurrent patellar dislocation. Am
J Sports Med. 2010;38:2248–2254. [PubMed]
4.
LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone
Joint Surg Am. 2007;89(9):2000–10 [Epub 2007/09/05].
5.
Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med.
1998;26(1):59–65 [Epub 1998/02/25].
65
PCL With Posterolateral Corner Injury
Dr. Shafi, Fellow, Sports Injury Centre
Dr. Himanshu Gupta, Assistant Professor, Sports Injury Centre
The anatomy of the PLC includes the fibular collateral ligament (FCL), the popliteofibular ligament (PFL), and
the posterolateral capsule, which are the primary static stabilizers, and the popliteus tendon, which is an important
dynamic and static stabilizer. Combined, these structures provide restraint to both posterolateral rotation of the
1,2
tibia and varus opening forces. Combined PCL and posterolateral instabilities result in severe functional
disability due to pain, instability, and degenerative changes in the knee. There is a consensus of opinion that
surgical reconstruction is indicated in knees with combined PCL and posterolateral instabilities.3
4-8
4
Various studies have reported the results of combined PCL with PLC injury .Wang (2002) reported that
combined arthroscopic PCL reconstruction and posterolateral reconstruction achieved 64% satisfactory (24%
excellent and 40% good) and 36% unsatisfactory (24% fair and 12% poor) results over an average of 32 months
of follow-up. In a retrospective study of the results of combined arthroscopically-assisted posterior cruciate
ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or
more months) symptomatic instability and pain in the knee Khanduja et. al ( 2006) seven patients (37%) had no
residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five
patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of
41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9). Kim
et al ( 2013) in a study of 46 patients with combined PCL and PLC injuries concluded that simultaneous
reconstruction of the PCL and PLC is recommended when addressing PCL injuries with mild grade 2 or less
posterior translation combined with posterolateral rotary instability.
PCL Reconstruction
PLC Repair
Refrences
66
1.
Jung YB. Recent evolution of cruciate ligament surgery of the knee. Clin Orthop Surg. 2012;4(2):103–106.
2.
Noyes FR, Barber-Westin SD. Posterior cruciate ligament revision reconstruction, part 1: causes of surgical failure in 52 consecutive
operations. Am J Sports Med. 2005;33(5):646–654. [PubMed]
3.
Harner CD, Hoher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med. 1998;26:471–482. [PubMed]
4.
Fanelli GC, Edson CJ. Combined posterior cruciate ligament-posterolateral reconstructions with Achilles tendon allograft and biceps
femoris tendon tenodesis: 2- to 10-year follow-up. Arthroscopy 2004;20:339-45.
5.
Noyes FR, Barber-Westin SD. Surgical restoration to treat chronic deficiency of the posterolateral complex and cruciate ligaments of the
knee joint. Am J Sports Med 1996;24:415-26.
6.
Wang CJ. Injuries to the posterior cruciate ligament and posterolateral instabilities of the knee. Chang Gung Med J 2002;25:288-97
7.
V. Khanduja, H. S. Somayaji, P. Harnett, M. Utukuri, G. S. E. Dowd .Combined reconstruction of chronic posterior cruciate ligament and
posterolateral corner deficiency. JBJS VOL. 88-B, No. 9, SEPTEMBER 2006.
8.
Kim SJ1, Lee SK, Kim SH, Kim SH, Jung M. Clinical outcomes for reconstruction of the posterolateral corner and posterior cruciate
ligament in injuries with mild grade 2 or less posterior translation: comparison with isolated posterolateral corner reconstruction. Am J
Sports Med. 2013 Jul;41(7):1613-20.
Rotater Cuff Injury
Dr. Pawan, Senior Resident, Sports Injury Centre
Dr. Vivek Shankar, Assistant Professor, Sports Injury Centre
The rotator cuff is a group of muscles and tendons that form a cuff over the shoulder joint. These muscles and
tendons hold the arm in its joint and help the shoulder joint to move. The tendons can be torn from overuse or
injury.
The study shows that the addition of medial-row fixation to a knotless repair construct significantly increases the
biomechanical characteristics of the repair (linear stiffness, ultimate load, and hysteresis) while significantly
decreasing gap formation regardless of tissue quality. The modified construct shows improved biomechanical
properties when allowing for external rotation during high-load testing. Using an additional horizontal mattress
from separate sutures in the medial-row anchors helps to neutralize forces experienced by the repair.
Clinical Relevance: The use of knotless suture anchors appears quick and easy to perform; however, most of the
anchor systems could
The undersurface repair technique as described in this article is significantly faster than previous repair techniques
used by us. Patients have less pain at 3 months and 6 months postsurgery and better motion at 6 months
postsurgery with equivalent retear rates and American Shoulder and Elbow Surgeons scores.
References
1.
Kummer F, Hergan DJ, Thut DC, Pahk B, Jazrawi LM. Suture loosening and its effect on tendon fixation in knotless double-row rotator
cuff repairs. Arthroscopy. 2011 Nov;27(11):1478-84. doi: 10.1016/j.arthro.2011.06.019.
2.
Kaplan K, ElAttrache NS, Vazquez O, Chen YJ, Lee T. Knotless rotator cuff repair in an external rotation model: the importance of
medial-row horizontal mattress sutures. Arthroscopy. 2011 Apr;27(4):471-8.
3.
Mall NA, Lee AS, Chahal J, Van Thiel GS, Romeo AA, Verma NN, Cole BJ. Transosseous-equivalent rotator cuff repair: a systematic
review on the biomechanical importance of tying the medial row. Arthroscopy. 2013 Feb;29(2):377-86
4.
Dierckman BD, Goldstein JL, Hammond KE, Karas SG. A biomechanical analysis of point of failure during lateral-row tensioning in
transosseous-equivalent rotator cuff repair. Arthroscopy. 2012 Jan;28(1):52-8.
67
All Inside ACL Reconstruction
Dr. Rahul, Senior Resident, Sports Injury Centre
Dr. Ajay, Assistant Professor, Sports Injury Centre
The all-inside ACL reconstruction technique is a modification of the full tibial tunnel technique whereby the
1,2
tibial bone tunnel is eliminated in favor of a tibial socket. The all-inside technique has been hypothesized to
result in less pain compared with full tunnel ACL reconstruction2,3 and has been biomechanically evaluated,4,5
This technique eliminates transosseous tunnels and large incisions by using the flipCutter to create a tibial
socket. This minimally invasive technique may reduce patient morbidity, swelling, soft tissue hematomas and
can simplify rehabilitation. The all-inside technique allows anatomic single or double bundle socket creation
with a variety of fixation methods. This technique is also useful for ACL reconstruction in adolescents where
epiphysis are not fused.
A Randomized Controlled Trial was done comparing All-Inside Anterior Cruciate Ligament Reconstruction
technique with Anterior Cruciate Ligament Reconstruction with a full tibial tunnel. They concluded that there was
no difference between all-inside ACL reconstruction and ACL reconstruction with a full tibial tunnel based on
IKDC scores, KSS score, SF-12 score, narcotic consumption, and tibial and femoral widening, whereas all inside
ACL reconstruction results in a lower VAS pain score compared with baseline.6
References
168
1.
Lubowitz JH. No-tunnel anterior cruciate ligament reconstruction: The transtibial all-inside technique. Arthroscopy 2006; 22:900.e1900.e11. Available online at, www.arthroscopyjournal.org.
2.
Smith P, Schwartzberg R, Lubowitz J. No tunnel 2-socket technique: All-inside anterior cruciate ligament doublebundle
retroconstruction. Arthroscopy 2008;24:1184-1189
3.
Smith P, Schwartzberg R, Lubowitz J. No tunnel 2-socket technique: All-inside anterior cruciate ligament doublebundle retroconstruction.
Arthroscopy 2008;24:1184-1189.
4.
Tsai A, Wijdicks C, Walsh M, Laprade R. Comparative kinematic evaluation of all-inside single-bundle and double-bundle anterior cruciate
ligament reconstruction: A biomechanical study. Am J Sports Med 2010;38:263-272.
5.
Walsh M, Wijdicks C, Armitage B, Westerhaus B, Parker J, Laprade R. The 1:1 versus the 2:2 tunnel-drilling technique: Optimization of
fixation strength and stiffness in an all-inside double-bundle anterior cruciate ligament reconstruction A biomechanical study. Am J
Sports Med 2009;37:1539-1547.
6.
James H. Lubowitz, M.D., Randy Schwartzberg, M.D., and Patrick Smith, M.D.Randomized Controlled Trial Comparing All-Inside
Anterior Cruciate Ligament Reconstruction Technique With Anterior Cruciate Ligament Reconstruction With a Full Tibial Tunnel.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 29, No 7 (July), 2013: pp 1195-1200.
The Modern Reverse Total Shoulder Arthroplasty
Dr. Navdeep, Fellow, Sports Injury Centre
Dr. Ankit Goyal, Assistant Professor, Sports Injury Centre
Key aspects of the modern reverse total shoulder arthroplasty include (1) a large glenosphere component with no
neck, which allows medialization of the center of rotation and reduced torque on the glenoid component; (2) a
humeral implant with a nonanatomic valgus angle, which moves the center of joint rotation distally, thus
maximizing the length and tension of the deltoid to increase its ability to abduct the humerus, in addition to
1-3
providing increased stability; and (3) a greater range of shoulder motion prior to impingement.
Center of rotation
Distal displacement of the center of joint rotation
increases the lever arm of the deltoid and also recruits
portions of the anterior and posterior heads of the
deltoid to act as abductors of the arm, permitting
elevation above shoulder height. In addition,
reestablishment of the subacromial space permits
greater potential abduction prior to impingement.
Reverse total shoulder arthroplasty has been shown to
provide pain relief and improve function. Promising
results of reverse total shoulder arthroplasty for the
treatment of rotator cuff-tear arthropathy have led to
its expanded use, and it has now become a surgical
option for failed conventional total shoulder
arthroplasties, patients with rheumatoid arthritis and an
irreparable rotator cuff tear, proximal humeral tumors,
and proximal humeral fractures with anterosuperior
escape.However, rates of instability, implant loosening,
infection, fracture, and other complications remain
high, demonstrating the importance of strict patient
selection, operative experience, close patient follow-up
for several years, and future design modifications
Diagram demonstrating the modern design, with a large glenosphere, a
nonanatomic valgus angle of the humeral implant, and medial and distal
positioning of the center of rotation.
References
1.
Basamania CJ. Hemiarthroplasty for cuff tear arthropathy. In: Zuckerman JD, editor. Advanced reconstruction shoulder. Rosemont:
American Academy of Orthopaedic Surgeons; 2007. p 567-78.
2.
Rockwood CA Jr. The reverse total shoulder prosthesis. The new kid on the block. J Bone Joint Surg Am. 2007;89:233-5.
3.
Boileau P, Watkinson D, Hatzidakis AM, Hovorka I. Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear
arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg. 2006;15:527-40.
4.
Gerber C, Pennington SD, Nyffeler RW. Reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2009;17:284-95.
5.
Middernacht B, De Wilde L, Mol´e D, Favard L, Debeer P. Glenosphere disengagement: a potentially serious default in reverse shoulder
surgery. Clin Orthop Relat Res. 2008;466:892-8.
69
10
Single Bundle ACL Reconstruction
Dr. Manoj, Senior Resident, Sports Injury Centre
Dr. Deepak Joshi, Senior Specialist, Sports Injury Centre
ACL reconstruction involves replacing the torn ACL with tissue taken from patient (autograft) or taken from
a tissue donor (allograft). This procedure is usually done arthroscopically and involves making tunnels in the
femur and tibia allowing passage of the graft material in order to reconstruct the ACL.
The fixation device for graft in ACL reconstruction should be secure and allow graft healing within the tunnel.
Because more aggressive rehabilitation program has been adopted in ACL reconstruction recently, the strength of
fixation device should be enough to allow immediate range of motion exercises, weight bearing, and early return
to sports without any loss of fixation strength. Over the past 10 years, significant advances in fixation have led to
the development of many different fixation devices for bony and soft tissue graft fixation.
1. Aperture Fixation Device
Metal or bio- interference screws are most commonly used aperture fixation for bone plug(BTB/Quadriceps
graft) in ACL reconstruction. With the increasing use of hamstring soft tissue grafts, bioabsorbable interference
screws, poly-L-lactic acid (PLLA) screws, and polyglyconate screws are becoming more popular. While the
bioabsorbable screw has the advantages, such as incorporation into the surrounding tissue, almost no need for
implant removal, and less interference with MRI, it seems to provide clinical results similar to those of metal
screws according to a systematic review.
2. Cortico cancellous Fixation Device
Cross biodegradable pins (Rigid Fix) and Transfix (Arthrex) can also be used for the fixation of soft tissue
graft. When used in ACL reconstruction using a hamstring tendon, they produce clinical results that can be
comparable to those of reconstruction using interference screws and the EndoButton. They have the maximum
pull out strength as compared to other fixation device but causes significant tunnel dilatation. With preference for
more anatomical transportal technique for femoral tunnel placement, these implants are no longer preferred, as
they are commonly are used with transtibial technique.
3. Cortical suspensory fixation device: These devices almost account for more than 80% of femoral graft
fixation devices used world over. The EndoButton CL (Smith & Nephew Endoscopy, Andover, MA, USA), is
the most popular fixation device for the hamstring graft on the femoral side. Although EndoButton has a higher
failure load and less stiffness than interference screws, it induces some micro motion of the graft within the bone
tunnel during loading, and can be a cause of tunnel widening(Bungee and windshield wiper effect). Baumfeld et al.
reported that 2 cross pin fixation resulted in less femoral tunnel widening than the EndoButton fixation. On the
other hand, Kong et al. suggested that the clinical results were comparable between the cross pin fixation and
EndoButton fixation and there was no significant difference in femoral tunnel widening between the two fixation
devices.
The ACL TightRope RT (Arthrex, Naples, FL) is a newer fixation device that makes ligament fixation fast, easy,
and secure. The TightRope button is attached to graft through a loop that can be tightened even after insertion
into the canal. The adjustable loop allows the surgeon some freedom in terms of the length of the femoral socket,
eliminates the need for bothersome intraoperative calculations for selecting loop length, ensures that the socket is
completely filled with graft, and provides the possibility of tensioning the graft even after graft fixation. It also
allows for all inside ACL reconstruction, which preserves tibial bone.
References
70
1.
Current trends in anterior cruciate ligament reconstruction. Duquin TR1, Wind WM, Fineberg MS, Smolinski RJ, Buyea CM. J Knee Surg.
2009 Jan;22(1):7-12.
2.
Freedman KB, D'Amato MJ, Nedeff DD, Kaz A, Bach BR., Jr Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis
comparing patellar tendon and hamstring tendon autografts. Am J Sports Med.2003;31:2–11.
3.
Prodromos CC, Fu FH, Howell SM, Johnson DH, Lawhorn K. Controversies in soft-tissue anterior cruciate ligament reconstruction:
grafts, bundles, tunnels, fixation, and harvest. J Am Acad Orthop Surg.2008;16:376–384.
4.
Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH. Anatomic double-bundle anterior cruciate ligament reconstruction.
Arthroscopy. 2006;22:1000–1006.
Current trends in SLAP repair
Dr. Jitesh, Fellow, Sports Injury Centre
Dr. Pallav Mishra, Assistant Professor, Sports Injury Centre
SLAP stands for superior labral anterior and posterior. Various authors have shown that tension within the bicep
tendons improves the torsional rigidity of the abducted, externally rotated shoulder (1) .Simulated SLAP tears
with compromise to the biceps anchor result in increases in anterior and inferior humeral head translation(2).
Classification: Type I lesions are described as superior labral fraying with localized degeneration and are
common in middle-aged patients. The superior labral and biceps anchor attachments remain intact and patients
are generally asymptomatic.
Type II lesions are the most common clinically significant SLAP tears. These tears are characterized by
detachment of the superior labrum/biceps anchor from the glenoid, and demonstrate abnormal mobility of the
labrum and biceps anchor.
Type III lesions represent a bucket-handle type tear of the superior labrum that does not extend into the biceps or
result in instability of the biceps anchor.
Type IV lesions have a bucket-handle tear of the superior labrum with extension of the labral tear into the biceps
tendon itself creating a split appearance.
TREATMENT
Type I lesions may be debrided when they are significantly frayed, but such lesions do not necessarily require
treatment. Unstable type II lesions should be repaired when the history and physical examination are consistent
with a SLAP tear, particularly when the arthroscopic examination does not reveal other shoulder pathology.
Degenerative type II tears associated with other lesions typically do not require repair, especially in older or less
active patients. Type III lesions are treated with resection of the unstable labral fragment and repair of the middle
glenohumeral ligament if the ligament is attached to the torn fragment.
Treatment of type IV tears depends on the extent of biceps tendon involvement and the age of the patient. When
<30% of the tendon is involved, type IV lesions are typically treated with debridement of the labral tear and of its
extension into the biceps. Tears involving >30% of the biceps tendon generally are treated with biceps tenodesis
and labral repair in younger patients or in older patients with labral debridement and biceps tenotomy or
tenodesis.
References
1.
G. C. MALLO, P. GOLIJANIN, D. J. GROSS, P. W. MURPHY, M. T. PROVENCHER. SLAP repair current update. MINERVA ORTOP
TRAUMATOL 2014;65:305-19
2.
Burkart A,Debski RE, Musahl V, McMahon PJ. Glenohumeral translations are only partially restored after repair of a simulated type II superior
labral lesion. Am J Sports Med 2003;31:56-63
3.
Edwards SL, Lee JA,Bell JE, Packer JD, Ahmad CS, Levine WN et al. Nonoperative treatment of superior labrum anterior posterior tears:
improvements in pain, function, and quality of life. Am J Sports Med 2010;38:1456-61
71
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SPORTS
TRAUMATIC INJURY AND
* NEUROLOGICAL
DAMAGES
- improves trophicity.
- faster regeneration after surgery.
- for effective lymphatic drainage.
MIN
5min
SYNDROMES
* PAIN
-promotes mobilization;
INTEN
S
alleviates muscles stiffness;
positive effect on fatigue, fears & depression.
Menu
Select
Mob. +919711001722, 01125437540
H-33,
,
Srinagar / Chandigarh / Dehradun, Patna / Kolkata /
Bhubneshwar, Jabalpur / Bhopal, Mumbai / Pune, Chennai
75
76
77
Experience Live Demonstration of
latest in Sports Injury related
Arthroscopic Surgery of Knee & Shoulder
Live Streaming from Sports Injury Centre, VMMC &
Safdarjung Hospital to Hotel Le Meridian
27th – 28th June, 2015
The Sports Injury Centre provides one stop solutions for
sports related injuries and ensures complete recovery of
sports professionals through its 'State of the Art' Surgical
and follow-up facilities. More than 7000 complex Knee &
Shoulder Arthroscopy procedures performed here over
last 5 years – some exceptionally rare & done for the 1st
time not only in India but also globally. The Centre has a
dedicated team of Surgeons, Sports Medicine Specialists and Physiotherapists. The Centre was approved by ISAKOS in
2012 to impart specialized training in the field of Arthroscopy &Sports Medicine.
Renowned International Faculty and Eminent Indian Faculty Performing Live Surgery:
Dr. Mark Ferguson (South Africa), Dr. Paul Sethi (USA) & others
Glimpses of facilities at Sports Injury Centre
• MRI CT Scan • Digital X ray • Bone Densitometry • Pathology Lab • OPD Consultation • 24 Hrs Emergency • PAC Checkup
• Physiotherpy OPD • Electrotherapy • Gymnasium • Hydrotherapy • Dietician • Sports Psychologist • Operation Theatres • Biomechanical Lab
www. sportsinjurycentresjh.nic.in Email: [email protected]
www.facebook.com/sportsinjurycenter
www.facebook.com/first.sic.india
twitter.com/FirstSic
www.facebook.com/events/880783718641581/
www.facebook.com/events/1101554856551434/
SPORTS INJURY CENTRE, SAFDARJUNG HOSPITAL, NEW DELHI-110029
78
Recent Advances in Rehabilitaion
Spine Concept
Spine Profile
AFTER
BEFORE
Cervical
Mobility
Back
Extension
LS/TS
IMPROVEMENT
Refrence Value
Strength
Rotary
Torso
Back
Lat Flexion
Abdominal
Flexion
Cervical
LS/TS
Cervical
Strength
Relation
Cervical Extn
Lat Flexion
EVE
LS/TS
30
20
10
0
10
20
30
aluated
Hip & Knee Concept
Knee Flexion
Multi Function
Leg Press
Lat
Pulldown
Abduction
Knee
Extension
Adduction
Shoulder
Concept
Rowing
Torso
Lateral
Raise
Pec Dec
Chest Press
Mob. +919711001722, 01125437540
H-33,
,
Srinagar / Chandigarh / Dehradun, Patna / Kolkata /
Bhubneshwar, Jabalpur / Bhopal, Mumbai / Pune, Chennai
Design & Printed By : Design Arts
9811055058

Document 1468803

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