Delving into knee and ligament health


  • Metro News
  • Monday, 20 Jan 2020

Participants listening to the presentation by speakers during the StarLIVE talk held at Menara Star in Petaling Jaya. - Photos: AZLINA ABDULLAH/The Star

KNEE osteoarthritis (OA) is the most common joint disease among the elderly. It is the second highest condition that causes disability, after diabetes.

Age, weight, genetics, trauma caused by repetitive movements such as climbing stairs and squatting, involvement in physical labour occupations, poorly controlled inflammatory joint disease, malalignment of limbs and poor muscle strength are common risk factors for the disease.

Women have a higher risk of experiencing knee OA.

Ara Damansara Medical Centre (ADMC) consultant orthopaedic surgeon Dr Ling How Tieng said this in his StarLIVE talk entitled “Knee Osteoarthritis”, which saw an attendance of over 180 at Menara Star in Petaling Jaya.

The talk, under the theme, “Orthopaedic Health Getting You Moving”, was organised by Star Media Group Bhd and Ramsay Sime Darby Health Care.

Dr Ling, who has 18 years of experience in orthopaedic surgery, said the condition was most common in patients aged 50 and above.

“It is a degenerative joint disease, affecting all structures that form a joint, particularly cartilage, bone, ligaments and capsule.

“It is not just wear and tear of the knee, but there is a mild element of inflammation in this condition. It is considered joint failure, ” Dr Ling explained.

He stressed that it may also occur among young individuals who are active in sports or those who have had injury when they were young.

“There is no cure for knee OA. When there is damage to cartilage, it is irreversible. It can no longer function effectively to protect the bone. Cartilage is a specialised tissue at the end of the bone between the thigh bone, leg bone and kneecap, ” he pointed out.

Dr Ling added that most people would only consult specialists when they already had knee OA.

“The problem is cartilage has no nerve so when it is injured, no

signal is sent to the person. They will not come for treatment at an early stage.”

He explained that treatments basically acted as symptomatic relief for patients.

“There are various forms of treatments and it depends on the severity of knee OA. In severe cases, the treatment includes medication and surgery, ” he said, adding that total knee replacement surgery could cost RM25,000.

He said they would advise making lifestyle changes to minimise pain.

“Those who are obese are advised to lose weight. If they can reduce weight by 10%, they can reduce symptoms of knee OA by 50%. It is the cheapest way of treating knee OA, ” he said.

Dr Ling added that patients should not perform exercises that further burden the joints.

“Such patients should not go jogging or hill climbing as it makes it worse. They can go swimming or do static cycling. Static cycling is a very good form of exercise for people with knee OA as it actually strengthens the muscles.”

Causes of knee OA, he said, included knee injury, obesity, hereditary and repeated knee bending.

Symptoms include joint ache and soreness, especially with movements, he added.

“If they feel discomfort when squatting, climbing stairs or praying, they should consult an orthopaedic surgeon to diagnose their condition and help slow the progress of the disease.

“If you have noise in your joint when climbing stairs, squatting or standing up, this is probably an early symptom of knee OA.”

Dr Ling added that some patients experienced stiff joints for fewer than 30 minutes, tight muscles around the joint and limited joint movement.

On the method used to manage pain, he said they include medication (applied physically or taken orally), injection or cold pad (a non-pharmacological way to relieve pain).

He said some people would experience “mechanical” pain after overuse of joints such as after a holiday or hiking trip.

“They can also have acute pain for knee OA and it can last up to a few days or weeks. During that time, the joint will be swollen and warm, ” he added.

ADMC consultant orthopaedic surgeon and academic Assoc Prof Dr Gandhi Nathan Solayar, spoke about anterior cruciate ligament (ACL) reconstruction surgery.

Dr Gandhi, who has 14 years of experience in orthopaedic surgery, said ACL surgery was performed to reconstruct the torn ligament in the patient’s knee.

“It prevents the tibia (shin bone) from sliding forward, provides stability when rotating the knee, prevents knee dislocation in combination with other knee ligaments, and proprioceptive function (joint sense), ” Dr Gandhi added.

On the ideal candidate for ACL surgery, he said they would include patients aged younger than 40, those active in sports, professional athletes, those involved in physically demanding jobs (army, heavy lifting), those who had meniscus injuries (especially younger patients) and other ligament injuries and revision surgery (for those who had previously failed ACL surgery).

The surgery usually takes one-and-a-half hours and costs between RM30,000 and RM40,000, he said.

Dr Gandhi added that women were more at risk for ACL reconstruction surgery, while those involved in certain sports such as football have a higher tendency for the condition, and it is more common among younger people and those who had previous ACL injury.

Early symptoms of ACL injury, he said, included swelling, pain, locking, difficult weight bearing and inability to continue playing for athletes.

Late symptoms, he added, include knee instability (giving way), meniscal tears, locking and stiffness.

On diagnosing ACL injury, he said, it would involve checking the patient’s history, physical examination and radiological investigations (X-ray, ultrasound and MRI or magnetic resonance imaging).

“MRI also indicates whether other specialised tissues in the knee are torn, if there is a fracture or other ligaments are torn. It gives a good idea of the extent of injury in the knee.

“We also use knee arthroscopy to confirm the ACL tear and in the same surgery, we can reconstruct ACL, ” he explained.

Citing reports, he shared that there was a 85% success rate for ACL reconstruction surgery.

Dr Gandhi said the surgery could be performed using the patient’s own tissue (autograft), which is considered superior compared to donor tissue (allograft).

He added that there were different reconstruction options, including using the patient’s hamstring tendon (hamstring muscles are the group of muscles at the back of your thigh), patellar tendon (the structure at the front of your knee that connects the kneecap to the shin bone) and quadriceps tendon (large tendon just above the kneecap) for the ACL surgery.

“I reserve the use of allograft (donor) tissue for complex, multiligament surgery cases where multiple ligaments are torn around the knee and occasionally, in revision cases.

“Patients who have had ACL surgery done previously may not have sufficient tissue from their own body so, in those cases, I may choose to use donor tissue, ” he said.

Dr Gandhi added that allograft tissue was specially processed in designated laboratories around the world to make sure it was safe for use in surgeries.

In Malaysia, Dr Gandhi said tissue banks were available in Universiti Malaya and Universiti Sains Malaysia.

“If unavailable, we may import donor tissue from special laboratories abroad, ” he added.

The audience also took part in a question-and-answer session with both speakers after the talk.

Retired corporate secretary Chin Fah Yew said she found the talk very informative and that the presentations were very “light, practical and easy to understand.”

Quantity surveyor MK Yeong, said the talk was good and provided useful tips.

“The speakers have delivered the information in a fun way.”

The first 100 attendees also received a free foot assessment to analyse whether they have conditions that affect their ability to walk.

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