‘Over 90% of sports injuries in Oman involve the knees’
Football causes the maximum number of sports injuries in Oman, of which knee injuries are the most common. Over 90 per cent of patients visiting most orthopaedicians and sports clinics in the country suffer knee injuries due to the national game.
“Football and knee injuries sum up sports injuries in Oman,” said Dr E B S Ramanathan, orthopaedic and sports medicine surgeon from Muscat Private Hospital. “Over 90 per cent of the patients attending my sports clinic suffer injuries due to football. Of this nearly 90 per cent suffer an injury to the knee joint.”
He said that once the Anterior Cruciate Ligament (ACL) ruptures especially in a young patient, the only option is surgery – ACL reconstruction. This means a new ligament (Graft) has to be placed in the knee to replace the original damaged ACL. Taking the replacement from the patient is the best option and is known as Autograft. The two most common grafts in use worldwide are Hamstring and BTB Patella tendon graft. “About our experience in Oman, I have found BTB to be superior and more suitable for our patients.”
Diabetes is a burden in the region. However “the issue of diabetic athletes is not an issue here”, he said. “Generally diabetes is not a contra-indication for sports provided they are careful with their diet, eating habits and taking their medication regularly. As we all know, moderate sports like walking etc is mandatory for managing diabetes. Even amongst professional athletes diabetes can reach high levels – the best example is Wasim Akram the great fast bowler from Pakistan who was a diabetic from an early age and took injectable insulin therapy but still played at the highest level.”
The flip side to sports is definitely sports injuries, he said. “Generally sportsmen who play contact sports are more prone for degenerative changes (Osteoarthritis) in their knee and hip joints at a younger age than the general population. In footballers damage to knee structures like the meniscus and ACL are the two most common injuries leading to early osteoarthritis.
“I don’t have hard facts but definitely 30 to 40 per cent of the footballers go on to have early osteoarthritis. This will necessitate Total Knee Replacement (TKR) later but is usually done when they reach 55 to 60 yrs of age.”
Dr Parag Sancheti, professor and chairman, Sancheti Institute for Orthopaedics and Rehabilitation in India is a visiting orthopaedic surgeon to Oman. Talking about his experience in the sultanate, he said, “On an average we have more than 100 patients per annum visiting Sancheti Hospital for treatment of various sports injuries.”
He said that the most common sports injuries are those related to the knee, ankle and shoulder. These would depend on the type of sports played. “As football is a major sport in Oman, the most common injuries are those related to the knee of which the tear of ACL, which is the key stabiliser of the knee joint and meniscal injuries are predominant.
“The most common reconstruction surgeries in my experience in Oman are the arthroscopic reconstruction of the cruciate ligaments of the knees.”
Dr Sancheti said that as these ligaments are not repairable “they are reconstructed by using grafts”. “These grafts can be obtained from the same body in the form of muscle or tendon and they are called Autografts. Allografts and Synthetic grafts can also be used as a substitute for Autografts.”
He said that chondral injuries are also common in sports persons. “The treatment of chondral injuries would depend on clinical and radiological assessment. It ranges from conservative treatment to arthroscopic microfracture technique, mosaic plasty and autologous chondrocyte reimplantation.
“Other than knees, the most commonly injured parts in sportsmen are the shoulder and the ankle. Shoulder injuries including rotator cuff tears and instability are very common and can be well treated.”
Dr Ramanathan said that physiotherapy is one of the most important modality of treatment for sports injuries. “In any form of sports injuries the earliest form of treatment is physiotherapy. After ACL reconstruction too physiotherapy is mandatory and very important.”
Experts from the field are of the opinion that the most important tool in diagnosis of sports injuries is still clinical examination. After that the two most important investigations are ultrasound and Magnetic Resonance Imaging (MRI). “The reason being that most sports injuries involve soft tissues like muscle injury, ligaments, meniscus, etc. which are all soft tissues and cannot be seen in an X-ray, which reveals only bone injuries,” Dr Sancheti said.
Also, ultrasound has many advantages - it is not costly, easily available and can be done immediately in the Emergency Room if necessary. “MRI should be used as a second line, though it is very useful in most sports injuries. MRI does not involve radiation, so it is safe. Only CT Scans or X-rays involve radiation,” Dr Ramanathan added.