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The nature, profile, and incidence of sport injuries has changed hugely over the past few years, says a Mediclinic Kloof orthopaedic surgeon.
In recognition of Orthopaedic Month, he discusses knee injuries and the evolution of treatment methods.
Why major sports-related knee injuries are on the increase
“In adolescents with sports injuries, it was traditional for doctors to see kneecap dislocations and the odd ligament or meniscal injury,” says Dr Shaun East, an orthopaedic surgeon at Mediclinic Kloof. “But today, especially with sports like netball, rugby, and hockey becoming more competitive, we’re treating a lot more major injuries.”
Adolescents as young as 13 are now presenting with cruciate ligament injuries, sprains or tears in the knee ligaments connecting the thighbone to the shinbone. Big meniscus tears and even femur fractures are also increasingly common, particularly among rugby players. “Incidents have climbed almost tenfold compared to pre-COVID levels,” says Dr East. While performance pressure may be a factor, he also attributes this to broader social trends and the impact of the pandemic.
Among adults, there’s been a marked return to physical activity, especially in people in their 30s-50s, he adds. “People want to exercise more and go from zero to hero, in the gym and on trails, riding hundreds of kilometres on their bikes or doing triathlons.”
Common knee injuries
This sudden spike in activity can cause stress fractures, particularly in your tibia and feet. Meniscus and medial collateral ligament (MCL)injuries are also more common. “As you get older, the meniscus, the cushioning between your thigh and shin bones, becomes more brittle, and tears more easily. This can lead to complications like early arthritis,” Dr East explains.
Muscle imbalances also contribute to issues like patellar (kneecap) dislocation and malalignment. “Your muscles get weaker with age. It’s easier to exercise the easy muscles and harder to work the difficult ones, creating imbalances. This may lead to anterior knee pain and poor joint alignment.”
MCL tears are seen particularly among rugby players. This ligament, located on the inner side of the knee, connects your thigh bone to the shin bone. Dr East says conservative treatment – using braces, physiotherapy and biokinetics – is usually effective, and most patients recover without surgery.
The rise of joint preservation
Traditionally, patients aged 60-65 with early onset arthritis would be considered for knee replacements. However, Dr East says in the past these surgeries sometimes resulted in long-term complications.
“Today, we have different options like viscous supplementation, which increases lubrication in the joint. Both sides of your knee joint are weight bearing and create friction, so we add a viscous supplementation injection to decrease this. It also decreases the inflammation that drives arthritis. If the inflammation in your knee is managed, we can preserve it for longer without immediately doing a knee replacement.”
Traditional treatment suppresses inflammation using medications and gels. However, for patients with early-onset arthritis, encouraging some inflammation may actually boost healing and repair. That's where treatments using a patient's own stem cells or blood-rich plasma become valuable.
“Through platelet-rich plasma (PRP), we draw blood, spin it in a centrifuge, and use the plasma, which contains healing factors, to treat partial injuries like ACL or meniscus tears,” Dr East explains. “This creates a super-sized inflammatory reaction to promote healing, without the need for surgery.”
Do I need knee replacement surgery?
When conservative methods are no longer effective, you may need knee replacement surgery. Dr East asks patients three key questions:
- What level of pain are you experiencing?
- Are you able to perform normal daily tasks?
- Has the shape of your leg changed?
If you’re affected by at least two of these issues, your doctor will consider knee replacement surgery.
How knee replacements have improved
Total knee replacements have come a long way over the past 15 years. “Older implants were aggressive as you had to remove a lot of bone, and recovery could take up to nine months,” Dr East explains. “Today, prostheses are more ergonomically designed, surgical tools are better, and patients often return to work within 4-6 weeks.”
Knee replacements are no longer just for over-65s. Surgeons now operate when necessary, managing ongoing care to avoid dangerous medication side-effects while preserving quality of life. However, competitive athletes should wait until retirement to prevent damaging the prosthesis.
On the road again after knee reconstruction
Runner and cyclist Cheraye Engelbrecht tore her anterior cruciate ligament (ACL) while training for a Comrades Marathon qualifier. After failed surgery and poor advice to stay immobile without physiotherapy, she suffered chronic pain and couldn't straighten her leg. She eventually found Dr East, whose exceptional care made all the difference.
“After an in-depth assessment, he discovered the previous surgeon had used the wrong screws and inserted them at an incorrect angle. The knee was bending inward, and the area was also infected,” she says. Dr East removed the screws, cleaned the site and took bone samples in preparation for reconstructive surgery.
Under Dr East's supervision, Engelbrecht spent nine months rebuilding strength with a biokineticist before successful ACL reconstruction surgery. “Before I was discharged, I had to be able to climb stairs, and I started physiotherapy immediately – completely different from my first experience.”
Four years later, Engelbrecht is back to running 21km races, defying expectations. “I feel like myself again. Just being able to run without pain is amazing,” she says.
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