Orthokinetics Blog
Articles about knee conditions, sports injuries, treatments and procedures, and many more
Why There Is No Single Best Orthopaedic Treatment for Your Condition: Tailoring Care to Individual Needs
There is no single best orthopedic treatment due to differences in individual patient factors. The optimal approach depends on a person's age, health, lifestyle, resources, and financial ability.
In orthopaedics, there is no universal "best" treatment for any condition because the optimal approach depends on individual patient factors and requirements. Some considerations include age, activity level, other existing medical comorbidities or problems, availability of resources (surgeon skill set, availability of equipment, adequacy of hospital support), and financial considerations. The most effective treatment plan is one that is personalized to meet the specific needs of the patient in the specific circumstance the patient is in. A good medical professional will focus on sharing medical knowledge and options with his patient with a collaborative view to determine the best course of action rather than solely promoting new technologies or dogmatically following traditional treatment pathways.
Introduction
Orthopaedic treatment is a field characterized by a wide range of options, from surgical interventions to non-surgical treatment such as physical therapy, medication, lifestyle changes and supportive therapy like TCM (Traditional Chinese Medicine). Given the complexity of musculoskeletal conditions and the diversity among patients, there is no single "best" treatment for any given orthopaedic condition. Instead, the most appropriate treatment is one that is tailored to the individual needs and circumstances of the patient. This article explores why personalized care is crucial in orthopaedics and the various factors that influence treatment decisions.
Common Knee Injuries in Sports
Patient Age
Age is a significant factor in determining the most suitable orthopaedic treatment. Younger patients, particularly those who are active and in sports, may benefit from more aggressive interventions to return to their previous level of activity quickly. It also allows the active individual to return to the activity with the joint biomechanics repaired to it’s optimal level, thereby reducing further injuries. For instance, a young athlete with an ACL tear might undergo reconstructive surgery to ensure long-term stability and functional recovery.
In contrast, older patients with similar injuries might be treated differently. For example, an elderly patient with an ACL tear may be managed conservatively with physical therapy and lifestyle modifications, especially if they have lower activity demands or other health issues that make the risks of the procedure outweigh it’s benefits.
Activity Level
The patient's activity level and lifestyle play a crucial role in treatment decisions. Active individuals or athletes often require treatment plans that prioritize quick recovery and return to high-performance activities. Surgical options or intensive rehabilitation might be recommended to meet these needs.
On the other hand, a sedentary person with the same condition might be managed with less invasive treatments, focusing on pain relief and maintaining functional mobility rather than achieving high-level athletic performance.
What is important is to have a realistic expectation of what the treatment can or cannot do for you. If the patient could not do a certain manoeuvre or action which caused the injury in the first place (eg. Sidestep or pivot in a certain way), surgery will not result in the patient being able to do that manoeuvre or action. It is like bringing a damaged car to a workshop. After the repairs, you still get a car back. You do not receive a tank after the repairs.
Medical Comorbidities
The presence of other medical conditions can significantly impact treatment choices. Patients with diabetes, cardiovascular disease, or obesity might face additional risks with certain treatments. For instance, surgical options may be considered with caution due to increased risk of complications or slower healing.
In such cases, conservative treatment approaches, such as physical therapy, weight management, or medication, may be preferred to minimize risks and improve overall health outcomes. Coordinating with other healthcare providers to manage comorbidities is often a critical component of the treatment plan.
Availability of Implants and Resources
The availability of specific implants and resources can influence treatment decisions. In some cases, newer technologies or specialized implants might offer benefits, but they may not always be accessible or appropriate for every patient. For example, certain advanced prosthetic devices or biologic fresh frozen grafts may not be available in all locations or might be cost-prohibitive.
Orthopaedic surgeons must work within the constraints of available resources while still striving to provide the best possible care. This means balancing the latest advancements with practical considerations to ensure that patients receive effective and feasible treatment.
Financial Considerations
Financial factors can also play a significant role in treatment decisions. The cost of various treatments, including surgery, rehabilitation, and ongoing care, can vary widely. Insurance coverage and out-of-pocket expenses may influence which options are practical for a patient.
In some cases, more expensive treatments might offer marginal benefits over less costly alternatives. A comprehensive approach considers both the clinical benefits and the financial impact to ensure that patients receive care that is both effective and manageable within their financial means.
The Role of the Medical Professional
A good medical doctor does not simply dictate the best treatment but rather collaborates with the patient to determine the most appropriate plan based on a thorough understanding of their individual needs. This process involves:
Patient Education: Effective treatment begins with educating patients about their condition, treatment options, and potential realistic outcomes. A well-informed patient is better equipped to make decisions that align with their goals and preferences.
Joint Exploration: The decision-making process should be collaborative, involving discussions about the benefits, risks, and limitations of various treatment options. This joint exploration ensures that the chosen plan reflects the patient’s values and priorities.
Personalization of Care: Each patient’s unique circumstances, including their health status, lifestyle, and personal preferences, must be considered when developing a treatment plan. Personalized care helps optimize outcomes and patient satisfaction.
Encouraging Thoughtful Decision-Making
Patients should seek healthcare professionals who prioritize comprehensive evaluation and patient education and willingness to discuss the pros and cons of various options over those who focus primarily on the latest technology or treatments. While advanced technologies can offer significant benefits, they are not always the best fit for every patient. A thoughtful, patient-centered approach is essential for achieving the best possible outcomes.
Conclusion
Orthopaedic treatment is not a one-size-fits-all field. The absence of a single "best" treatment for any condition underscores the importance of personalized care. Factors such as age, activity level, medical comorbidities, availability of resources, and financial considerations all play a crucial role in determining the most appropriate treatment plan.
A good medical professional will focus on educating patients, exploring their needs, and collaborating to develop a treatment plan that best fits their individual circumstances. Patients should seek out healthcare providers who offer thoughtful, personalized care rather than those who focus solely on the latest technologies. By doing so, they can ensure that their treatment aligns with their goals and leads to the best possible outcomes.
The Importance of the Meniscus to Knee Function
The knee is one of the most complex joints in the human body, and plays a crucial role in nearly all athletic activities. Consequently, the knee is highly susceptible to injuries, especially in sporting activities.
The knee joint is a marvel of anatomical engineering, balancing stability, mobility, and load-bearing capacity. Central to its function are the menisci—two crescent-shaped pieces of cartilage located between the femur (thigh bone) and tibia (shin bone). Despite their relatively small size, the menisci play a critical role in maintaining knee health and function.
Anatomy and Function
Each knee contains two menisci: the medial meniscus on the inner side and the lateral meniscus on the outer side. These structures serve multiple vital functions:
Load Distribution: The menisci act as shock absorbers, distributing the load and stress placed on the knee joint during activities such as walking, running, and jumping. By spreading out the forces exerted on the knee, they help prevent excessive wear on the articular cartilage, which covers the ends of the bones and enables smooth movement.
Joint Stability: The menisci contribute to knee stability by improving the fit between the femur and tibia. They enhance the congruence of these bones, which is crucial for maintaining joint alignment and preventing excessive movement that could lead to instability or damage.
Lubrication and Nutrition: The menisci aid in the distribution of synovial fluid, which lubricates the joint and supplies nutrients to the articular cartilage. This fluid helps reduce friction during movement and facilitates the maintenance of cartilage health.
Force Absorption: During high-impact activities, such as jumping or sudden directional changes, the menisci absorb and dissipate a significant portion of the forces transmitted through the knee. This absorption reduces the stress on the underlying bone structures and helps prevent injuries.
Meniscus Hoop Stress
One of the critical functions of the meniscus is its ability to manage hoop stress—a type of circumferential stress that occurs around the meniscus when the knee bears weight. The meniscus’s unique wedge shape allows it to distribute forces radially, which is crucial for offloading pressure from the cartilage and protecting the knee joint.
Hoop Stress Mechanics: When the knee is loaded, the meniscus helps to create hoop stress, which is a force that acts circumferentially around the knee joint. This stress is generated as the meniscus attempts to resist the compressive forces and spread them evenly across the joint surface. By doing so, it reduces the localized pressure that would otherwise be applied directly to the articular cartilage.
Pressure Offloading: The hoop stress generated by the meniscus allows for better distribution of the compressive loads across the knee joint. This reduces the peak pressure exerted on the articular cartilage, minimizing the risk of cartilage damage and subsequent joint degeneration. Essentially, the meniscus acts as a buffer, or “shock absorber”, protecting the cartilage from excessive wear and tear.
Impact of Meniscal Injury
Meniscal injuries can significantly impair these functions, leading to various complications:
Pain and Swelling: A torn meniscus often results in pain, swelling, and stiffness in the knee, which can impair mobility and functionality.
Joint Instability: Damage to the meniscus can disrupt the normal biomechanics of the knee, due to jamming of the torn material between the 2 bones and leading to instability and an increased risk of further injury.
Cartilage Degeneration: Over time, meniscal tears can accelerate the degeneration of the articular cartilage. Without the protective effect of hoop stress, the cartilage may experience increased pressure and wear, raising the risk of developing osteoarthritis—a chronic condition characterized by pain, swelling, and reduced joint function.
Treatment and Management
The management of meniscal injuries depends on several factors, including the extent and location of the tear, the patient's activity level, and overall knee health. Treatment options may include:
Conservative Care: For minor meniscal tears (eg. free meniscal edge fraying, intrasubstance or partial tears), rest, physical therapy, and anti-inflammatory medications can often provide relief and facilitate healing.
Surgical Intervention: In cases of severe tears (eg. Full thickness tears or displaced fragments) or persistent symptoms, surgical options such as meniscectomy (removal of the damaged portion) or meniscal repair may be necessary. Surgical treatment aims to restore knee function and alleviate pain while preserving as much of the meniscus as possible.
Conclusion
The meniscus plays a fundamental role in the function of the knee joint by distributing loads, stabilizing the joint, facilitating lubrication, absorbing forces, and managing hoop stress. Understanding the importance of the meniscus underscores the need for prompt and appropriate treatment of meniscal injuries to preserve knee health and function.
Athletes and active individuals should be particularly vigilant about knee health. If you experience symptoms such as persistent knee pain, swelling, or a sensation of catching or locking, seek professional medical evaluation promptly. Early diagnosis and treatment of meniscal injuries are crucial for preventing further damage and ensuring a full recovery. Taking proactive steps now can help safeguard your knee joint, enhance your performance, and prevent long-term complications.
Traditional Chinese Medicine Therapy For Sports Injuries
The combination of both TCM and orthopaedic management may provide even better results when it comes to sports injury management as this allows the injury to be managed in a balanced and objective manner, combining the benefits of both conventional and traditional medicine.
This article is written with the intention of providing information to the general public rather than with an academic or research focus.
Traditional Chinese Medicine offers holistic approaches to treating sports injuries, including acupuncture, herbal medicine, tui na (traditional deep tissue massage), cupping therapy and others. These therapies are believed to provide numerous health and healing benefits to the body. While is known to help in symptomatic relief of minor injuries and preventive care, athletes should also be cognizant of potential risks and controversies surrounding TCM treatment. For proper assessment and safe management, it is important to consult only trusted and qualified TCM practitioners and seek the help of sports orthopaedic surgeons if the injury is severe or if the symptoms are persistent.
Exploring Traditional Chinese Medicine Therapy for Sports Injuries
Injuries often hamper athletes and sports enthusiasts as they push their limits to perform better. While conventional medical treatments are widely accepted and utilized, there is a growing interest in alternative approaches such as Traditional Chinese Medicine (TCM). TCM is rooted in ancient Chinese philosophy, focusing on balancing the body's energy (Qi), enhancing blood flow, harmonizing bodily functions and nourishing the body. TCM practitioners often look at the athlete holistically rather than solely focusing on the injured area. Central to TCM philosophy is the concept of qi (pronounced "chee"), the vital energy that flows through meridians in the body. The proper balance and flow of qi is believed to lead to health and wellbeing. TCM treatment aims to improve recovery by allowing proper flow of qi in the body. There are various modalities of treatment for TCM therapy. These include acupuncture, herbal medicine, tui na (deep tissue massage), cupping therapy, and dietary supplementation, all aimed at restoring balance and harmony within the body. Below is an elaboration of some of these key therapies:
Acupuncture: Involves inserting fine needles into specific meridian points on the body to affect Qi flow. This is believed to assist in pain reduction and healing. Today, acupuncture therapy has also been offered as a form of complementary medicine in public hospitals in Singapore (1,2).
Herbal Remedies: Utilises plant-based substances to reduce inflammation and promote tissue repair. They are also used for nourshing the body to promote faster recovery after intense training and to treat exercise induced fatigue.
Tui Na (Massage): A form of therapeutic massage to improve circulation, alleviate pain, and support recovery.
Cupping: Cupping treatment involves placing suction cups on body areas experiencing pain or discomfort. This form of therapy has also been described in Greek history. The purported effects of use of this therapy are to balance Qi, aid in ejection of pathogenic factors and improve circulation. Even prominent Olympic athletes such as Michael Phelps have been photographed showing signs of cupping therapy as observed by news reporters. (3)
Michael Phelps spotting circle marks from cupping therapy (Source: Elle)
Advantages of Traditional Chinese Medicine Therapy
One of the key advantages of TCM therapy is the whole-body approach in evaluating and assessing the patients. While conventional medical treatment usually focuses only on the area of injury or a known medically related condition which affects various symptomatic areas, TCM practitioners often view the balance and harmony of the entire body as the most important issue. Additionally, TCM also emphasizes preventive care, overall well-being and continued nourishment of the body, which can benefit athletes by allowing them to stay longer in their sports.
Disadvantages, Risks, and Controversies
Despite its long history and widespread use, TCM is not without its drawbacks and controversies. Some critics raise concerns about the lack of scientific evidence supporting certain TCM practices. While TCM has centuries of anecdotal evidence and positive patient outcomes as validation, it is deficient in the area of rigorous scientific validation in the form of controlled clinical trials when compared to conventional medical treatment. This has led to skepticism about their efficacy and criticism that the positive effects may be placebo in nature. There are also reports of potential side effects of herbal remedies. These adverse outcomes may stem from challenges in tracing the origins of herbs to ensure authenticity and detecting contaminants or additives introduced during processing. Additionally, the qualifications and expertise of TCM practitioners may vary, leading to inconsistent quality of care. Thus, it is essential for patients seeking TCM therapy to weigh these factors carefully and consult only trusted and qualified TCM practitioners who obtain their herbal products from reputable sources.
Making Informed Decisions
In the journey to return to sports after an injury, prompt and comprehensive assessment is crucial. While TCM therapy may offer numerous benefits, it’s greatest impact is being part of a comprehensive multiprong approach to treat sports injuries. If the sustained sporting injury is severe (eg. Inability to weight bear for lower limb injuries or inability to carry loads for upper limb injuries) or symptoms do not improve despite TCM therapy, it would be wise to consult an orthopaedic specialist in addition to undergoing TCM therapy. Your orthopaedic surgeon will perform detailed evaluation, order additional imaging investigations such as Magnetic Resonance Imaging (MRI), provide accurate diagnosis and advice on necessary treatment as well as estimated recovery time.
Conclusion
In conclusion, exploring traditional Chinese medicine therapy for sports injuries can provide athletes with additional avenues for healing and recovery. However, the combination of both TCM and orthopaedic management may provide even better results as this allows the injury to be managed in a balanced and objective manner, combining the benefits of both conventional and traditional medicine. Going forward, it is encouraging to see that some TCM practices have already incorporated conventional orthopaedic medical considerations in their management plan by inviting orthopaedic doctors to be part of their advisory committee. By leveraging the expertise of TCM therapy alongside the precision of contemporary orthopaedic treatment principles, the trajectory of holistic patient care appears poised to facilitate expedited recovery and swift resumption of activities for athletes and sports enthusiasts.