Sports Injuries

The Orthopeadic Clinic - Sports Injuries Division within the Athens Medical Center consists of a plethora of doctors and medical scientists who work together on a daily basis so as to provide the best possible medical care in Greece.

Specialized sport scientists, top in their field, including physicians, physical therapists, rehabilitation trainers, nutritionists offer their services in alignment with international guidelines in both Europe and the United States of America.

We are well aware that injuries affect not only the athlete but his team as well and therefore we always work in close cooperation with the coaching staff of the sports club so that they are kept up to date during every aspect of the athlete’s rehabilitation.

The Clinic enjoys wide recognition both within Greek boundaries as well as internationally, with a constant presence in International Conferences and Seminars and numerous publications in International Scientific Journals. Additionally, it offers training opportunities and fellowships to younger doctors and participates in Orthopaedic Research Programs.

The Clinic is a pioneer in all new diagnostic and therapeutic methods always striving to achieve the best possible outcome. Our goal is to educate, prevent and treat sport related injuries in close cooperation with physical therapists, trainers, radiologists so as to provide athletes with an individual and specialized rehabilitation program following surgery.

Related Videos

Knee disorders

 

 
     
     

Athens Medical Center

Dr. Pantelis K. Nikolaou, MD, PhD

  • Former head doctor of Olympiacos, AEK, and the National Greek Football team.
  • Received the “O Donoghue” award from the AOSSM
  • Received the “Kappa Delta” award from the AAOS

Dr. Nikolaos Piskopakis, MD, PhD

Director of Sports Medicine Dept.

  • Former Sports’ team doctor for many Greek teams incl. National ones
  • Former President of the Hellenic Orthopaedic and Traumatology Association
  • Member of the AAOS

Related Articles

12.07.16
Shoulder Arthroscopy: When is it necessary?

Written by Nikolaos Piskopakis, MD, PhD Orthopaedic, ex President of Hellenic Arthroscopic Society, Director of Sports Medicine Department, Athens Medical Center, Athens Medical Group

Shoulder arthroscopy may be used to treat the following:

Subacromial impingement syndrome - (Acromioplasty)

It is a pathology of the rotators’ tendon, and mainly the supraspinatus, which may involve both young athletes and older people. The tendon of the rotors protects the head of humerus and it is located just below the acromion, creating the subacromial space, which is protected by a popliteal bursa.

When lifting the hand upwards the subacromial space is reduced and consequently the rotors’ tendon is injured. This may get worst as time goes by, creating a painful inflammation, which may even lead to rotors’ rupture. The causes that may lead to this is the form of the acromion, mainly its front surface, the presence of osteophytes, and any muscular atrophy that may occur after injury, leading to continuous impingement of the tendon to the subacromial space. Subacromial impingement syndrome treatment may be conservative and, if the symptoms persist, surgical - arthroscopic.

Acromioclavicular joint arthritis (Shoulder Arthritis)

Shoulder arthritis causes intense pain and shoulder motion weakness, and it should be managed.

The acromioclavicular joint is the contact point between the clavicle and the front inner part of the acromion. This area is normally characterised by a small space, which allows the clavicle’s micromotion and contributes to the composite motion of the shoulder.

As time goes by, in young athletes, but especially at more advanced ages, acromioclavicular degeneration - arthritis with presence of osteophytes may occur due to the repeated impingement of the area. This arthritis causes intense pain and shoulder motion weakness, and it should be managed. Shoulder arthritis surgical treatment comes after conservative treatment failure, and the arthroscopic technique can give excellent results.

Shoulder instability repair (Bankart lesion) - Shoulder Dislocation

Glenohumental joint is an unstable in nature joint. Both dynamic and static factors contribute to the stability and great range of motion that characterise it. These are the shoulder girdle muscles and the ligaments of the shoulder region. During possible injuries with the hand usually in abduction and external rotation, a displacement of the humeral head and its sliding out of the glenoid is usually caused. More often, this may occur in a forward direction (anterior dislocation), and less frequently in backward direction. In some young people it may contribute to more frequent presence of dislocations, an idiopathic relaxation of the shoulder’s joint. Shoulder instability is a pathology which definitely requires surgical treatment in young people. Today, it has been demonstrated that results are better when shoulder instability is treated in a timely manner, and arthroscopic treatment comes first. In some special cases open surgical repair is also indicated.

Long head of biceps repair (slap lesion)

The long head of the biceps tendon is a very strong tendon and is one of the two brachial biceps muscle’s tendons. The long head of the biceps tendon contributes to the humeral head stability relative to the glenoid. The long head of the biceps tendon is in contact with the rotors’ tendon, and anatomically it is attached to the humerus on the groove of the biceps. It adheres to the glenoid, at its top part, and it is in direct contact with the labrum. After long-term use and repeated micro-injuries inflammation may occur, with intense symptoms of pain both during movement and at rest. At more advanced ages in particular, degeneration of the tendon fibers is also present, which can be easily and with very good results managed arthroscopically through the biceps tenotomy method. In cases of damage coexisting in the rotors’ cuff, it is possible to perform, always arthroscopically, tenodesis of the long head of the biceps and repair together with the rotors’ damage. In young athletes of throwing sports mainly, a pathology of long head of the biceps tendon detachment from the glenoid may occur (SLAP LESION), which is only arthroscopically treated with good results and athletes’ rehabilitation.

Calcific tendinitis

The deposition of calcium salts - calcific (shoulder tendinitis) is a very painful shoulder pathology. Shoulder tendinitis mimics the symptoms of subacromial impingement, with severe pain that does not resolve easily with conservative treatment. The symptoms of shoulder tendinitis may last from 1 week to over a month. Calcium salts deposition in the mass of the rotors’ cuff and concomitant bursitis of the subacromial bursa cause the above symptoms.

After conservative treatment (anti-inflammatory – physiotherapy – local cortisone injection) symptoms resolve, without requiring radiological disappearance of calcification. In persistent cases that do not respond to conservative treatment arthroscopic treatment of the syndrome has excellent results in shoulder tendinitis.

20.05.14
Arthroplasty for Congenital Dislocation of the Hip with a new technique and special biologically incorporated implants

In case that hip osteoarthritis is caused by congenital dislocation or dysplasia, thus of non centering of the hip head to its anatomical position, during birth or inside the uterus before birth, but in a higher or much higher position, hip arthroplasty, as conducted until now by most orthopedic specialists, thus to replace the hip head to its anatomical position, is a very heavy operation, usually accompanied by many complications (hemorrhage, nerve contusions, clotting etc.) as well as many failures and heavy and dangerous re-operations. This usually happens because, from the age of one up to 40 or 50, when osteoarthritis is appearing, especially for cases in which the hip dislocation is accompanied with leg length discrepancy, are caused, over the years, due to body adaptation, rigid deformations to the pelvis and spinal cord, having as a result the operational rotation adapted center which fits the above deformations is not at the same position with other patients born with a normal hip.

Despite the effort of surgeons, with various additional operations, such as osteotomies of shortening of the femur or transections of many muscles around the hip in order to correct them, this is difficult to be achieved during the arthroplasty surgery. The burdening of arthroplasty with the above additional surgeries, in order to lower the hip down and to the inside, the main operation takes much longer from a simple arthroplasty and the risk of complications is greatly increased. In order to simplify the operation and make it safer, in recent years is used, here and abroad, the so-called «High or Higher Hip Center» technique, in which our team has played a prominent role in international scientific publications, since we are from among the first in Greece to apply this hip arthroplasty.

For the success of this technique do not usual fit the Press fit type cotyloid implants but are used cotyloid implants with special flaps, having the ability to be mounted and incorporated stable and biologically, with «osseointegration», thus with biological bone integration- same as with modern tooth implants, even to a cotyloid socket of full insufficiency of the roof or great malformation of the hip. The above cotyloid implants are mainly mounted to the back and side of the acetabulum in apposition where the most healthy bone foundation exists, in order for the arthroplasty to have a long and without problems duration.

The acetabulum placement to an adapted position higher than the anatomical one, in order to fit chronic malformations of the body of each patient (Pelvis, Spinal cord etc.) and not where it should be, if the patient would have been born with a normal hip, has a very good functional and permanent result with the patient suffering a very heavy and dangerous operation for the stabilization of the implant to the so called anatomic position. In cases that the rotational center of the joint of the hip was in normal position before osteoarthritis, as is it happens in cases of post-traumatic osteoarthritis and not to congenital dislocation, it is mechanically unacceptable to place the cotyloid implant in a higher than the normal position. The aim is not to have a beautiful x-ray but a proper and functional result for each patient. The higher adapted to each patient position of the hip is equilibrated functionally by maintaining unchanged the tension of both the lever arm and proximal muscles. This operation helps to the reduction of leg length discrepancy or even to have same leg length, in cases that this is needed for better functional results. No additional surgeries are required such as osteotomies with plaques and screws to the femoral bone, used by older methods and requiring a difficult revision in case of breaking or infection, while they increase the time of anesthesia and operation and of course the risk of complications. The time of the operation is approximately one hour, like in a simple arthroplasty, patients need blood transfer and the charging of the limb is immediate, contrary to the existing up to now classic technique, during which the time of the operation is at least double, there is more blood and the patient stays in bed for many days and without charging the limb for approximately three months. 

By Nikolaos Christodoulou, Orthopedic Surgeon, Doctor of the University of Athens, Orthopedic Clinic Director, Iatriko Psichicou and Konstandinos Dialetis, Orthopedic Surgeon, Colleague of Iatriko Psichicou.

20.05.14
Arthroscopic Restoration of the Anterior Cruciate Ligament with a graft from the posterior femoral tendons

Dr. Nikolaos Piskopakis,MD, PhD Director of the Orthopedic Clinic of Sport Injuries,Athens Medical Center.

When the anterior cruciate ligament suffers a rupture or is injured, it could need an operation in order to get restored. This operation is realized with various methods. One of those is the restoration of the damaged ligament with a part taken by the posterior femoral tendons of the knee.

This article will help you understand: Which parts of the knee are involved, what is the method of the surgery execution, what one should wait before and after the surgery.

ANATOMY

Which parts of the knee are involved?

The ligaments are strong fibers connecting the joint bones together. The anterior cruciate ligament is at the center of the knee joint and connects the femoral bone with the tibia bone.

Anterior cruciate ligament rupture

The anterior cruciate ligament attaches in front of the intercondyloid eminence of the femoral bone and ends up to the tibia and specifically to the tibial spine.

The biceps femoris cover the largest part of the back side of the femur. It is a group of muscles made by three muscles and tendons thereof: semitendinosus, semimembranosus and the biceps femoris. The posterior femoral muscles start mainly from the ischial tuberosity, the small bone edge at the lower part of the pelvis, directly below the buttocks, are extended to back side of the femur, pass along the knee joint ending up to the two sides of the tibia. The graft used for the replacement of the anterior cruciate ligament is taken by the two posterior femoral tendons and specifically from the semitendinosus. Usually, the surgeon includes the tendon of the gracilis muscle found directly next to the semitendinosus.

OBJECTIVE

What is the objective of the surgeon?

The main objective of the operation of the anterior cruciate ligament is to limit the anterior slip of the tibia on the femoral bone, in a way that the knee joint to be able to move normally again. The options for the autologous graft are two: We could use a part of the patella tendon or part of the posterior femoral tendons of the knee. For some time the patella tendon was the first choice, because the surgeon has easier access to the graft, which fits well to its new position and heals quickly. But the big disadvantage is the acute pain caused to the anterior surface of the knee after the operation. The patient in such cases must avoid pressure to the tendon (f.e. kneeling). Due to this complication, for the last years the use of graft from the posterior femoral tendons has been the main choice. The final result and the symptoms presented after the surgery are almost the same in both cases. The strength and stability of the joint, as well as the ability to use the knee are the same, regardless of which graft will be used. The difference is that with the posterior femoral tendons as graft, the patient won’t have to face problems with kneeling and won’t feel pain to the front part of the knee.

PREPARATION

What you should know before the operation

The patient in cooperation with the doctor should decide if they will proceed to surgery. The patient must understand as much as possible the procedure of the operation and the doctor should answer any questions that might arise. As soon as the decision for the surgery is taken some steps must be taken. Initially, a full check must be done in order for the doctor to ensure that the patient’s condition allows the operation.

The patient could talk with a physiotherapist that will take over its recovery program, after the restoration of the rupture of the anterior cruciate, in order to be informed about the schedule that will be followed. Also some information will be asked concerning the present state of the patient, such as pain levels, movement and strength of each knee, as well as the ability of the patient to execute his/her activities. During preparation for the surgery, the physiotherapist may show to the patient how to walk safely using crutches.

SURGERY

What happens during the surgery for the restoration of the rupture of ACL?

Most surgeons execute this surgery using an arthroscope. The arthroscope is a small camera made by optical fibers and used by the surgeon in order to be able to see and operate inside the joint. Only 2 incisions are needed for the arthroscopy.

Before the operation some kind o anesthetic will be administered to the patient (full or local epidural). The surgeon begins the operation by making two small incisions to the knee, called gates. Those gates are used for the admission of the arthroscope and other surgical tools to the interior of the knee joint, always very carefully in order to avoid injuries to nearby blood vessels and nerves. Then, another incision is made to the internal side of the knee, exactly to the point where the semitendinosus is attached to the tibia. Through this the surgeon removes the semitendinosus and the gracilis tendon. In case that the semitendinosus is sufficient, it is the only one used. Those tendons are placed in three to four batches in order to increase the strength of the graft. The bunches are held together with sutures. Then the surgeon prepares the knee in order to place the graft. All remainders of the damaged ligament are removed and the intercondyloid eminence is widened in a way that it does not touch the graft. This part of the operation is called notchplasty.

ARTHROSCOPY

After the completion of this stage, the surgeon opens little holes to the tibia and the femoral bone to place the graft. Those holes are made in specific points, in order for the graft to be extended between the tibia and the femoral bone, exactly in the same way with that of the normal anterior cruciate ligament.

Then, the surgeon places the graft in the correct position and stabilizes it with absorbable screws and sutures to the holes opened earlier.

In the end, the surgeon places a small tube inside the knee joint in order to avoid blood and liquid concentration. Holes and skin incisions are closed with sutures and the operation is finished.

AFTER THE SURGERY

What will happen after the surgery?

Immediately after surgery, the patient could use a device of continuous passive motion in order for the knee to start moving and be relieved by rigidity. The device is attached to the led and begins making a continuous movement of bending and extension. This continuous motion has a result the reduction of rigidity and pain. It also inhibits the forming of additional scar tissue inside the joint. The continuous passive motion device is many times used in combination with cryotherapy . After most anterior cruciate ligament operations, the patient does not hospitalization and returns home at the same day. In some cases patients are hospitalized for one to two nights. The little tube placed to the leg of the patient is removed usually after 24 hours. The surgeon may suggest the use of a splint for some weeks after surgery. The patient will need crutches for two to four weeks, in order to keep the knee safe. In most case the placement of some weight to the leg when standing or walking is allowed.

RECOVERY

What to wait during recovery?

Usually after such an operation the patients follow a physiotherapy program. The first physiotherapies aim to reduce pain and oedema caused by the operation. The objective is the full restoration of the motion range as soon as possible.

The physiotherapist will chose exercises that will work out and strengthen once more the femoral muscles. The patients should not overuse the posterior femoral muscles, for six weeks after the surgery. For this reason, to this specific group of muscles are applied isometric exercises. Isometric exercises have the advantage to work out the muscles without burdening the joint.

With the progress of the physiotherapy program, the exercises are readapted, in order to have a safe strengthening and proper function of the knee. Special balance exercises are used to help the muscles respond directly when needed. This method is called neuromuscular training. If the patient should stop abruptly, the muscles should respond with the proper speed, control and direction.

After such a surgery, this ability does not return fully without exercise. Neuromuscular training has exercises that improve balance, muscle strength and agility. Agility is the one allowing the fast change of direction, the choice of going fast or slow and improves start and stop. These are important abilities for walking, running and jumping, especially for athletes.

When the patient would gain full motion abilities, the oedema would have fully disappeared and has recovered fully muscle control and knee strength του, will be in a position to return, step by step, in his/her work and sport activities.

Some surgeons propose to atheletes wishing to return earlier to their sport activities to wear some orthopedic assist. Ideally, after recovery the patient should be ready to return to all ordinary daily activities. However it is recommended to athletes to wait for 6 months approx. before returning. Doctors propose to most patients to find some way to exercise that is not burdening too much the knee joint.

The rehabilitation program will take four to six months, in order to achieve the best result after he restoration of the anterior cruciate ligaments. For the first six weeks the patient will have to visit the physiotherapist only two to three times per week. If all will go well with the operation and the rehabilitation program proceed per schedule, after this time period an exercise program will be given for the house and visits to the physiotherapist will be done scarcely for the next two to four months. 

By Dr. Nikolaos PiskopakisOrthopedic Surgeon, Director of the Orthopedic Clinic of Sport Injuries, Athens Medical Center.