Promptness prevents permanent damage

"I love running. Keeping fit is important to me and therefore, a running session three to four times a week, be it with the Hash on Sundays, Dubai Road Runners, Abu Dhabi Striders or just a bash in the desert, is part of my normal weekly routine," explained Richard Fowler, a GRP plant manager at Hepworth in Dubai.

Out in the desert a few years ago, Richard was running down a sand dune when his foot got trapped in deep sand and his body jolted forward. The result – a tender and sore knee joint. He decided to seek medical help and saw Dr Deepak Bhatia, consultant orthopaedic surgeon, Al Zahra Hospital, Sharjah.

"He had severe injury to his right knee when he came to me in September 1999," said Dr Bhatia. "He had twisted his knee severely and was not able to walk or take any weight on the leg."

An initial arthroscopic examination confirmed Richard had a torn cartilage and had also torn the main cross ligament of the knee (anterior cruciate ligament).

Following the initial minor cartilage surgery, Richard's knee buckled again eight weeks later when he tread on a rough stone. He was re-admitted in November 1999 when Dr Bhatia carried out reconstruction of his anterior cruciate ligament by arthroscopic means.

"The pain was intense," explained Richard, "my knee swelled up like a balloon and I put an ice pack on it but that did not work. When I went to see Dr Bhatia he explained I needed an arthroscopy. He explained the whole procedure to me."

Once the anterior cruciate ligament of the knee is torn it cannot be stitched or repaired. The old ligament has to be taken out and a new ligament put in. In the early Eighties orthopaedic surgeons in the U.S. inserted a few artificial ligaments but these failed within two to three years. In the late Eighties and early Nineties, good experience was gained using the patient's own tissue to form a new ligament.

In the operation carried out by Dr Bhatia, the middle one-third of the kneecap tendon was used to form the new ligament and using arthroscopic techniques (keyhole surgery or minimally invasive surgery) the new ligament was fixed into place with very fine titanium screws.

"As Dr Bhatia explained, the first 48 hours were a little uncomfortable," says Richard, "then they got me up on crutches and showed me how to walk down the corridor. I had cold water pack on the leg most of the time when I was lying down and by the time I went home in 10 days I was much more mobile."

Richard had physiotherapy sessions for two weeks and about one month after the surgery he started normal and light swimming activities.

"After two months I was ready to jog and at the end of three to four months the doctor said I could take part in contact sports, including football and rugby, using this accelerated rehabilitation programme."

Six months after the operation, Richard took part in a pursuit race with Hash and was thrilled at coming first. This trophy is very precious to him.

Dr Bhatia explained further that an injury to the anterior cruciate ligament of the knee can be very disabling. Often the patient is unable to walk or walk down the stairs without his knee buckling under him owing to the perceived weakness or instability.

The advantage of the above technique is that there is very little pain following surgery. No plasters are required and there is very little physiotherapy. The overall rehabilitation is very quick and the results consistently excellent. The tissue used to form the new ligament comes from the patient, so rejection by the body is not a problem.

Long-term results of such re-constructions are now available and remain excellent at 10 to 15 years following the surgery. There is also new evidence to suggest that long term risk of osteo-arthritis is minimal as the knee is stable after this surgery.

Recent advances of this technique, Dr Bhatia added, include the use of bio-degradable (dissolving) screws which are being used here and are easier to insert than the titanium screws. The other advantage of this being that sometimes metallic screws can cause pain or discomfort and need to be removed after a few months. The soluble screws do not need to be removed at a future date as they often dissolve in about six months following the operation.

In view of the knees and importance for mobility, it is not surprising that knee injuries are very disabling and it makes sense to do all you can to avoid them. Before any sporting activity is undertaken, it is important to be physically fit.

Jogging or bicycling – a small distance at first – are good for building up the knee muscles. In this way the knees are readied for taking greater stresses than usual and so are better protected.