The ski season may be popular but it also creates and exacerbates many knee injuries, making the early start to every year a busy time for orthopaedic surgeons. Here, Spire Washington Hospital’s consultant Mr Robert Gregory talks through options for those suffering from knee joint pain.
Who do you see most often in your consulting room?
I’m predominately a knee surgeon and the patients I see are generally broken into two groups – younger patients with sports-related injuries and older patients who may need a joint replacement caused by the effects of arthritis. I treat professional athletes as well as recreational ones and in terms of the latter, I see a lot of skiers from Christmas through to April and May who are looking for advice and potentially treatment because of pain in their knee.
When is someone with a ski injury likely to come and see you?
Ski patients fall into three groups. There are those who are going skiing and who want to know if the knee problem they are experiencing might stop them and / or what they can do to protect the joint. Then there are those who get a minor injury while they are away. They might come and see me because the problem is not getting better and they are worried about exacerbating the issue. Finally there are those who need further treatment because whatever they’ve done while on holiday is more serious and for the latter, the sooner they are seen, the better.
What process can a patient expect to follow?
Well for those still to depart, the first step is to make a diagnosis that may involve a scan. The objective is to assess how we can get them as fit as possible for skiing and this can involve the person seeing a physiotherapist. A very small minority of people require an operation, which is carried out well in advance of the ski break where possible. The good news is most patients don’t need surgery and we can rehabilitate them so they can go and enjoy their time away. It’s slightly different for those returning with a ski injury. Those with a minor issue again require a diagnosis and potentially a scan and are generally placed on a rehabilitation programme led by physiotherapists. However, skiers who have done significant damage (such as a cartilage tear or cruciate ligament injury) and who have been braced to provide support almost always need surgery - the key there is to decide whether they need it immediately or to try rehabilitation in case that is a viable route instead.
What is involved with surgery?
Most of the procedures carried out are straightforward and done by keyhole surgery. Patients with less serious injuries come in as a day case and are treated under general anaesthetic, which means they can walk in and walk out the same day. Each person is reviewed within a couple of days by a physiotherapist and is asked to attend an appointment with me within a fortnight, by which point I expect them to be well on the road to recovery (this does depend on the individual’s ability to heal). With more serious ligament injuries, this is a bigger operation, mostly done under keyhole and requires an overnight stay. The patient is more reliant on physiotherapy and a bespoke rehabilitation programme afterwards and recovery can take nine months to a year.
I have three tips. The first is if you have pain that prevents you from doing an increased level of exercise, a joint that keeps locking (causing you concern) or you have a previous minor injury that hasn’t improved, you should seek a medical opinion. The second is never to be afraid of asking your consultant what might appear to be a silly question, because there aren’t any silly questions. The third is the earlier a diagnosis can be made, the more positive the outlook will be because issues can be rectified and additional damage can be prevented so don’t hesitate if you think you may need help.