• Newsletter Autumn 2017


    Sport Doctors Australia Newsletter No: 10

    Autumn 2017
    Welcome to the autumn newsletter. Winter sports are busy across the country, with Australian
    rugby still languishing, and a Super Rugby team destined to meet its maker in the near future.

    The usual array of sports injuries- ACL tears, meniscal tears, ankle sprains- arrive at the surgery with evidence on best practice slowly changing my approach to many conditions.

    Within my practice I have a Sports Physician registrar, a second sports doctor, and currently a
    medical student. I am keen to use these opportunities to present sports medicine in a slightly
    different light to that seen in the major cities. Being based in a rural location, I have less involvement with elite athletes, though I do treat the occasional world champion. Many patients are farmers who try to continue to be active and delay retirement. Others are people injured at work. Many are
    merely “weekend warriors” with musculoskeletal injuries that interfere with their daily life. I am
    hopeful that these experiences will broaden the knowledge base and empathy of young doctors
    entering sports medicine.

    I endeavour to bring diagnostic and management principles to rural areas where people may not
    otherwise be able to access them. Examples may be to give a diagnosis for a patient with chronic
    groin pain; to discuss evidence available for specific exercise programs; to treat patients with
    extracorporeal shockwave therapy, platelet rich plasma injections, or hyaluronate injections.

    My experience is also that younger general practitioners are less likely to perform procedures such
    as joint injections, leaving very few practitioners in rural areas maintaining these skills. I continue to  be involved in GP and medical student education in an attempt to reverse this trend, and to insure that rural residents are not significantly disadvantaged in musculoskeletal injury management.

    ACL Tears
    Over the past few years much research has been published suggesting a role for conservative, rather than surgical, management of acute ACL tears.

    Some recent studies have suggested long term quality of life may not be improved by early
    reconstruction, return to previous level of sport is similarly not increased, and hamstring strains may be more common following ACL reconstruction. The rate of knee arthrosis, hamstring weakness, and anterior knee pain are other areas not improved, or worsened by surgery.

    Added to this complexity is the significant waiting period for surgery for those without private health insurance (up to 18 months), lack of physiotherapy resources in rural areas, and an inability to take time off work for treatment in those who may be self-employed. These and other factors (availability of surgeons, sports teams demanding surgery for their injured players) create an uneven playing field for those suffering ruptures.

    My experience is also that surgeons are reluctant to consider conservative treatment in younger patients, suggesting that surgery is necessary to ensure a comprehensive rehabilitation, as well as reduce the rate of future meniscal tears, even though there appears to be little evidence for this.

    My own approach is to individualise treatment, and use research as a discussion point with patients.
    I also explain that surgery may be delayed in most cases (depending on concurrent injuries) with a
    “wait and see” approach being reasonable. Many patients are quite happy to accept this, though I
    suspect the majority of patients with acute ruptures are channelled vie the local A&E Department to
    the orthopaedic clinic, and then on to surgery.

    Anecdotally, I find many general practitioners view with incredulity the suggestion that an ACL rupture in a young athlete may be treated conservatively. I suspect that dominance of orthopaedic
    surgeons in the teaching of musculoskeletal injuries to medical students, interns/ RMO’s and GP
    registrars may be at the heart of this.

    One conclusion that seem to be shared by those in both conservative and surgical camps is that
    comprehensive rehabilitation is needed, whatever treatment is used. Whether from a
    physiotherapist, or sports doctor/ physician/ orthopod/ GP when the former option is not possible, a
    structured, graded and long term program is required. I feel it is also essential to set realistic goals,
    given the frequent long term sequelae.

    I would invite all members yet to do so to check the updated Sports Doctors Australia website. Any
    members whose details change should also contact SMA to ensure that their address and contact
    details are current. The website address is: http://www.sportsdoctors.com.au/ .Please give feedback
    to Dr Gavan White at gwhite@synergy-sports.com.au .

    A reminder to all members that comments, letters, complaints and suggestions are all welcome.
    Thoughts on topics for discussion would also be appreciated. Feedback can be sent to SMA or
    emailed to me directly at: gareththomassport@gmail.com .

    “Longer-term quality of life following ACL injury and reconstruction” Stephanie R Filbay; British
    Journal of Sports Medicine Mar 2017, bjsports-2017-097552; DOI: 10.1136/bjsports-2017-097552

    Daniel Messer, Matthew Bourne, Ryan Timmins, David Opar, Morgan Williams, Anthony Shield
    British Journal of Sports Medicine Feb 2017, 51 (4) 363; DOI: 10.1136/bjsports-2016-097372.200

    2017 Asics SMA Conference; 25-28 October 2017; The Weston, Langkawi, Malaysia

    ACSEP GP Symposium; 24 June 2017; AAMI Park, Melbourne. www.acsep.org.au/calendar

    Understanding Acute Hamstring Injuries; 5 July 2017; University of Canberra, ACT; Building 12, Level B, Room 50. http://sma.org.au/conferences-events/professional-development-



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