Category: News

Professor Cathal J Moran SSC

My Bodyfix: The Anterior Cruciate Ligament (ACL) with Prof Cathal Moran

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Professor Cathal J Moran SSC

In last night’s episode of Bodyfix on RTE 1, Professor Cathal Moran, Consultant Orthopaedic Surgeon specialising in knee and shoulder at UPMC Sports Surgery Clinic, discusses how he manages ACL injuries.

In this episode, Kathryn Thomas meets Galway hurler and former All-Ireland champion David Burke, who tore his ACL (in his knee) during training, threatening his sporting career.

Click on the image to the left to watch on RTE Player.

For further information on Anterior Cruciate Ligament (ACL) Injuries or to make an appointment with a UPMC Sports Surgery Clinic clinician, please contact info@sportssurgeryclinic.com

 

‘Paul McGrath ‘ready’ for 84th cap after undergoing knee replacement surgery’

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This article by Oisin Doherty was published in the Irish Mirror on the 25th September 2023.

Paul McGrath has joked that he is ‘ready’ to earn his 84th cap for Ireland after undergoing knee surgery.

The legendary Ireland defender went under the knife to get a knee replacement at the Santry sports clinic in Dublin in recent days.

Taking to social media on Monday, the 63-year-old posted a snap of him leaving the hospital along with a caption that thanked the staff for their help.

“Thanks so much to Ray Moran and his team @SSCSantry for everything the past few days. Couldn’t have asked for a better crew ! New knee in and ready for my 84th cap, the old one owed me nothing.”

McGrath was rather infamously plagued with knee issues throughout his illustrious career and was forced to change his training regiment in order to be ready for the weekend.

It did little to hamper his impact on the pitch however, and the Dubliner had a fabulous career at club level for Manchester United and Aston Villa.

At International level, McGrath was capped 83 times for the Boys in Green and famously starred at the 1994 World Cup, where his performance against Italy at Giants Stadium is still spoken about fondly to this day.

Agriland Mind Yourself Series: Dealing with recurring joint pain.

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UPMC is excited to announce a new partnership with Agriland that focuses on farmers’ orthopaedic health.

The Mind Yourself Series provides insight into the physical challenges farmers face and offers advice on how best to manage and improve orthopaedic health — all so that farmers can improve their mobility, function, and overall well-being.

Across the series, we will introduce you to hardworking farmers from a range of farm enterprises who’ll share their orthopaedic concerns, and UPMC orthopaedic experts will offer guidance and advice on how best to minimise pain, maximise movement, and ensure that farmers are ready for the next farming challenge of the season.

The series will feature five videos and articles and will kick off on www.Agriland.ie in August.

Mind Yourself Series in association with UPMC.

As a farmer, orthopaedic health is essential for your well-being and your ability to stay working on your farm.

At busy times or when help is in short supply, it may seem easier to ignore your aches and pains or push through the agony of an old injury. But early intervention and timely treatment can have significant benefits in terms of pain relief, improved function, and prevention of further damage.

Progressive and persistent pain in your joints doesn’t mean that surgery is your only option. In fact, surgery is often a last resort and there are many other effective alternatives available.

Support network

A farm is a business, and as a farmer, you need to build a team and support network around you. That network may include a vet, a mechanic, contractors, or an accountant. But your own health is also critical to the success of the farm, never more so given the challenges of securing skilled labour.

Therefore, incorporating healthcare professionals into your network, or knowing where to go for help, will help sustain you and your farm.

“Farming is a physically demanding occupation,” Kalen O’Donahue, senior physiotherapist at UPMC Sports Surgery Clinic said.

“It involves a range of tasks, from heavy lifting and repetitive motions to prolonged periods of bending and standing.

“Over time, these activities can lead to orthopaedic issues that affect joints, muscles, bones, and overall mobility.

 

“The farmers that I see in clinic are dealing with things like lower back pain, shoulder problems, knee injuries, joint inflammation, and repetitive strain. Often, they are putting up with these problems for far longer than they should.”

So, what is the advice for farmers dealing with recurring pain in their joints?

Dealing with recurring joint pain

Firstly, seek professional help. Persistent pain, limited mobility, swelling, joint instability, or joint stiffness is not normal. It shouldn’t be accepted as something to put up with.

Secondly, the advice is to stop putting off seeking help. Early intervention will save time in the long run.

A chartered physiotherapist can often be your first stop to help evaluate your orthopaedic symptoms. At a first appointment, a physical examination, and a functional assessment, which assesses how the condition impacts daily work-related activities, will be conducted.

If necessary, diagnostic imaging in the form of MRI or X-ray may be needed to provide a better understanding of the situation. A treatment plan is then developed by the physiotherapist.

But what if farmers don’t have time to follow a treatment plan?

Practical, tailored treatment

Treatment plans that are focused on exercises, manual therapy, or some moderate lifestyles changes shouldn’t be disregarded or dismissed as impractical.

“We work to build a treatment plan that works for them,” O’Donahue, who routinely works with farmers attending UPMC Sports Surgery Clinic in Dublin, said.

“We know what is manageable and we understand the time that can and cannot be given to regular exercise.

“We might, for example, advise on simple exercises that can be done at home for 15 minutes, two to three times a week. Maybe that happens during the morning tea break, maybe it works better in the evening after dinner. It’s whatever works.

 

“Often these are simple exercises to improve movement in a joint or rebuild strength so that pain is reduced. We put the control back in the hands of the farmer and we work with them to ensure we get results, so they don’t have to grin and bear it for another season.”

O’Donahue added that sometimes allowing time for your body to rest and recover and getting enough sleep after physically demanding tasks such as dosing or following particularly busy times on the farm such as calving or lambing, is essential for tissue repair and overall well-being.

As a farmer, you will always prioritise your farm, the animals you care for, the crops you grow, and the machinery you use.

Prioritising your health

Prioritising your own health must also come into the mix. Neglecting personal health will ultimately impact the running of the farm.

Neglecting the aches and pains, or other issues, can cause minor issues to escalate into more severe conditions and perhaps have a more detrimental effect on the farm enterprise.

Early intervention and minding yourself today – taking care of your body now – will help ensure you continue with the work that you love on the land you love for years to come.

Read more about UPMC’s Orthopaedic Care for Farmers here.

Ask the Expert: Aches, pains, arthritis and joint replacements – Mr Niall Hogan

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Joining Pat Kenny was Dr Niall Hogan, Consultant Orthopedic Surgeon at UPMC Sports Surgery Clinic, to answer all your orthopaedic questions.

Listen to the interview here:

https://www.goloudnow.com/podcasts/the-pat-kenny-show-highlights-47/ask-the-expert-aches-pains-arteritis-and-joint-replacements-422213.

Robotic Surgery explained

Now, orthopaedic advancements, injuries, operations and recovery are on the operating table of discussion today. If you’ve got queries about your aches and pains and what might be done about them, text them to us at 53106 or WhatsApp at 087 1400 106. Our expert this week is Dr Niall Hogan, consultant orthopaedic surgeon at UPMC Sports Surgery Clinic.

Robotic knee surgery is something that is fascinating; you program the machine, and you stand back; can you explain?

Not quite, but it’s evolution. It’s a technology being brought into medicine. It’s already widely available in medicine, but in orthopaedic surgery, it’s relatively new. Certainly, in Ireland. It was introduced by an Australian surgeon, Stephen Brennan, in Cork, and then I was the first to use it in the Blackrock Clinic in Dublin in 2021. What can you use it on? What joints? You can use it on a number of joints, but predominantly I think knee surgery is the most relevant. I use it exclusively for knee replacement operations, and what we do is, say, a patient who has arthritis in their knee gets x-rays, they get a diagnosis confirmed, but then we get a CT scan, and we send that scan off to America at the moment to upload the software and make it compatible with the computer software. Then, on the day of surgery, we open up the knee and put in a special erase that will talk to the computer in the operating room, and we can fine-tune the position of the implant. It’s very accurate, very reproducible and reliable. Then, we bring the robot in to do all the cuts that we have asked it to do. Okay, so it will make the incisions at the beginning? Or does the surgeon make the incisions first? The surgeon will do that and put in the relevant probes or erase them, and then once we have worked out where we want to put the knee replacement on the computer screen, we can bring the robot in to do the accurate cutting. Okay, so it goes through bone and that.

What stuff gets replaced?

An artificial patella, or what is it? Well, a knee is made up of a number of bones, predominantly the femur or the thigh bone the tibia or the sin bone and also the patella is the knee cap at the front of the knee. Now, some surgeons will replace the kneecap all the time, and some surgeons will not. It’s not essential. What we will do is remove the artificial surface or just the cartilage layer that has been destroyed with a wafer of bone at the end of the thigh bone and the top of the shin bone, and then we will replace that with metal on both sides. Then there is an insert in between, which is a polyethene or plastic insert which is the bearing surface. Is that the synovial lining of the knee? It’s similar to plastic replacing the cartilage or the meniscus in the knee.

Okay, I presume it’s successful, or you wouldn’t be doing it. I mean how many have you done? How does it compare to the results from the classic way of doing it?

Well, I’ve done 50 now over the past year, and I feel my patients are doing an awful lot better. I think they are recovering quicker, and it’s slightly less invasive. There is less soft tissue trauma for the patient, and I believe it is more accurate; therefore, the patients will recover quicker and do better in the long term.

Bikini Hip explained

Now, I think the last time we were talking, I mentioned a thing called the bikini hip. Where they avoid cutting into the muscles like the classic hip operation, and therefore, recovery is much quicker.

Yes, and as I said before, there are various approaches to the hip. Anterior, lateral and posterior. The key thing is to get the surgeon to do your operation to be comfortable with whichever approach he or she feels is the most appropriate. Okay, now, many of the things you are talking about there are the product of age, like wear and tear, but there are other operations you are involved in involving sports injuries, like the ACL type treatments. How complicated are they and how successful are they because the athletes seem to get the very best, and they can make a recovery to the point where they can resume vigorous sport. Very much so, typically an anterior cruciate ligament tear is very traumatic for an athlete because they can’t play contact sports or pivoting sports, so it’s important that it gets fixed. Unfortunately, there is a nine-month recovery period for that post-operatively, but they can get back to full activity and full exercise gradually over a period, but usually, nine months is the period out of the sport. Yeah, it’s a long time in the short-ish career of a professional sportsperson. Yes, very much so; people now are very familiar with ACL, and people have access to MRI scans, and they get surgery quicker. Whereas, in the past, it would be a career-ending injury 25-30 years ago. People would not get back from this injury, whereas nowadays they do get back, but unfortunately, it’s the guts of one season that they have to spend on the rehab.

Typical Ankle injuries

What about ankle injuries? People often feel that when you have an ankle injury, there is always a weakness there, even after the treatment, and you’ve got it fixed. I mean, there is no such thing as a replacement ankle, I presume?

I mean, it’s a very complicated area, I would suspect. There are replacement ankles, and there are two real operations when people get arthritis of the ankle one is an ankle replacement, and one is an ankle fusion. The fusion is probably more durable and longer lasting. Whereas ankle replacements have a lifespan, and it’s a small joint that takes a lot of weight going through it when we walk, so they can be quite tricky the injuries themselves, people often twist their ankles and sprain ligaments which often recover but often if they break an ankle they do damage, and then they will get post-traumatic arthritis in the future.

Now, when you do an ankle fusion, does it limit the movement of the ankle? Could you go back to your rugby or your squash or your tennis? No, I would say because there is quite a restriction. Now, having said that, people who have ankle replacements are not playing sports or ankle fusions are not playing sports up to that point; they are already retired from that level of exercise. They have pain in their ankle, and a fusion stiffens their ankle, so the movement is reduced. Although, you do compensate through other joints around your foot and beneath your ankle as well. What your aiming for is to give someone a pain-free ankle and make sure they are able to walk on. Could they cycle, for example? Yes absolutely. And swim? Yeah. The age profile for people with ankle fusions is well over 50 or 60, and therefore, their level of exercise is usually tailored to their age profile.

Q&A

 What stage is surgery performed on bulging spinal discs?

Had an injection, no improvement, great pain. Low back pain is very common in the whole population, and everybody at a certain age will have a bulging disc. Some discs are bigger, and some are smaller. Is this what they call a prolapsed disc? 

Yes, a prolapsed disc or a herniated disc. Yeah, because I have one, and I was told to get walking, get yourself upright, and it might even put itself back. Well, again, initially talking to the GP or the physio, most of the treatment for this is non-operative; it’s the education of the patient, it’s low-intensity exercise, weight loss and time as well the disc will look after itself. If the disc is particularly big, it will put pressure on a nerve route, and that’s when people get sciatica and pain down their legs or electric shocks down their legs going into their foot and ankle, when that is very debilitating it doesn’t respond to treatment then you may need to see an orthopaedic or a neurosurgeon to decompress that nerve route.

I have one here about shoulder impingement. Can a shoulder impingement be dealt with in anything other than surgery? That’s from Dolores, and I don’t really understand what impingement means. I’ve heard of hip impingement, but what are these impingements?

Shoulder impingement is a restriction in the movement of a shoulder, and during the arc of movement, one will experience pain. That’s usually due to irritation or tendonitis of a combination of muscles called the rotator cuff muscles. They are a group of four small muscles around the top of the humerus bone, which stabilise that ball in the socket of the shoulder and allow the bigger muscles to work. When we get older, that rotator cuff gets degenerative, and it can become very irritable; therefore, when we move the shoulder, it can impinge. Usually, physiotherapy, non-steroid anti-inflammatory or steroid injections will help. If it doesn’t, then you are looking to see a shoulder surgeon who performs arthroscopic shoulder surgery and rotator cuff repair.

Yeah, I’m due to have minor surgery on a frozen shoulder which has lasted ten months now. Is it wise to have surgery for that?

Frozen shoulder is a very difficult condition for everybody, particularly the patient, but also for the doctor because we don’t know a huge amount about it. The capsule of the joint becomes very inflamed and sticky, and it causes pain initially. Intense pain for the first six months, and along with that, it causes stiffness. Whereby you have very little movement in your shoulder joint again is very debilitating for day-to-day activities, and then if you leave it for long enough, over the course of 18 months, it tends to resolve itself. Now, sometimes the pain and the stiffness are so severe that a surgeon will either opt for an injection. A steroid injection, hydrodistension of the joint, or they will do arthroscopic surgery to debride the capsule and try to release the adhesions.

Another one, I’m 64, and I’m told I should have a hip replacement, but afterwards, I have to give up running and football. Is there an alternative other than painkillers to allow me to continue sports for a few more years?

It’s debatable whether he would have to give up football or other activities that they want, like running. There are plenty of people who still run and play football after hip replacements, whether or not their doctor advises that or not. I suppose if you get it fixed now, you might have a career after your rehab. Whereas, if you leave it. Correct, I think the main thing is to get a hip replacement if you have pain and dehabilitation that affects your day-to-day life and then if it goes very well and you are able to play football, and you are able to run afterwards well, then that’s the patient’s decision and certainly, I wouldn’t object strongly to that.

I have a problem with my toes, the middle right toe is overlapping and squeezing the next outside toe, and it’s getting worse. I’ve tried toe dividers, too, but that doesn’t help. What can I do to stop it?

Again, surgery often is the answer to that problem. It often is associated with bunions of the big toe. The big toe cuts across and then compresses all the lesser toes, and they rise upwards. In that case, I think make a visit to a foot and ankle surgeon who can then assess the toes. They can realign the first toe and hopefully straighten all the other toes as well.

Someone else is asking about heel pain. What is it, what causes it and how to fix it?

Heel pain can happen in children and in adults. In children, it’s called severe disease, and it’s just a growth phenomenon. It’s traction on the growing point on the back of the heel. In adults, people talk about calcaneal spurs or plantar fasciitis. Again, a very difficult problem to deal with. Certainly, orthopaedic surgeons don’t operate on it; sometimes, they are injected, but the main treatment is physiotherapy and stretching. Unfortunately, it takes months and months for it to settle.

My husband is getting terrible pain in both the muscles in his arms and his wrist. None of the painkillers he has been prescribed are working for him. It started in one arm about three months ago, and now it has started in the second arm. Okay, that person certainly needs to see his GP. Does that sound like arthritis?

It could be arthritis; it could be bilateral shoulder rotator cuff problems or frozen shoulders. Sometimes when multiple joints cause trouble at the same time, then it might be a rheumatologist that this patient needs to see in case they have any evidence of inflammatory arthritis, which affects a number of joints at the same time.

Advice, please, on treating arthritis in feet, particularly on toes on the inside of the foot. Very painful. The GP mentioned metal plates.

Correct, the two major problems with the big toe we mentioned already, bunions or this one sounds like it is hallux rigidus so arthritis in that first metatarsal phalangeal joint, and if that is arthritic and sore, then that joint probably needs to be fused and a surgeon will either do that with screws or a combination of screws and maybe a metal plate.

Final general question, what is an injection of steroids useful for, and how long do they last?

Corticosteroids are very helpful for the treatment of arthritis, usually in a degenerative joint. It’s reasonable to perform a steroid injection every six months or so. After about 2 or 3 injections, its effectiveness wears off, and the patient then wants to move to the next step of treatment. Yeah, but it is a useful interim. Yeah, very much so. If it can buy time and kick the problem down the road, then it’s useful.

Ray Moran Medical Director SSC

‘HELP KNEE-DED , I am a surgeon specialising in knee reconstruction – here is why female athletes suffer ligament injuries more than men’ with Mr Ray Moran

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Read this Article with Mr Ray Moran, Consultant Orthopaedic Surgeon & Medical Director of  UPMC Sports Surgery Clinic.

https://www.thesun.ie/sport/gaa-football/10694989/female-athletes-knee-ligament-injuries-ray-moran/

This article was published in the Irish Sun by Andrew Ryan.

For more information on how to make an appointment with Mr Ray Moran, please contact raymoran@sportssurgeryclinic.com

Mr Ray Moran – brother of former Ireland and Man Utd star Kevin Moran – explained to SunSport: “A lot of the early data came from American female soccer players because it is huge over there.

There is clear data that shows the number of incidents per hour played would be about four times as frequent as fellas. Moran has treated copious amounts of high-level athletes, studiously examining and theorising the rate of incidents and the reasons behind them. The most credible theory, from his perspective, boils down to biology.

BODY LOGIC

He explains: “If you look at the male shape and female shape standing together, men are pretty much up-and-down, whereas women, because their hips are set further apart at the pelvis for pregnancy and babies and things like that, that is what we call a valgus alignment.

If you jump and land on that when it is already bending inwards, the moment of bending further is even greater. It is a very fundamental structural biological reality that you are aligned like that. It must play a fairly big role because with fellas, when you jump and land or change direction, it is an inward movement of the knee. If your anatomy is already aligned to move inward, it is hardly surprising that you are going to end up with increased risk. There are other areas that are mentioned, like hormonal and stuff like that; it is not as clear cut. There is some speculative stuff about ligaments being a bit more lax at various stages of the menstrual cycle, but I think the structural one stands out to me. Moran says that recovery time is largely consistent between the genders – ranging from six months to a year. Meanwhile, he documented the kind of programmes he often prescribes to patients in their rehabilitation. He also suggests that these same programmes can be used by players to mitigate the risks, even if they cannot be eliminated entirely. These include neuromuscular balance training and muscle strengthening. He adds: “We do testing here at four months and eight months, roughly speaking, after ACL reconstructions. The first thing we do is test the strength of the hamstrings and quads, and you compare the opposite side and normal values in relation to it. We have got a spread of the average and what the top 1% are at and all the rest so they know what to aim at.

There is also functional testing where, at the four-month test, we don’t want to do rotational stuff, so we would be doing jump, hop, and land and control. When we do the second test at about eight months, it is full on. It is a dress rehearsal for the return to function. We can advise at each of those stages what the changes to make are to their programme, feed that data back to their own physio, and we have fairly good data to show that the re-entry rate can be held to a very civilised level by following the programme. The influence of those programmes can apply to pubertal kids because young teenagers are quite prone to it as well. You will never get rid of the risks, but you can minimise them as best you can. You do it for males and females, but the need for it is greater for females because the risk factor is higher.”

WORK IN PROGRESS

Ray Moran stresses that risks of sustaining knee ligament injuries will not be avoided outright; however, as sports science continues to evolve, he is confident knowledge of how to mitigate against those factors will grow in tandem. There is a fair amount of input at a medical and paramedical level with teams nowadays. I think it is evolving all the time.

I think the use of a physio, probably the use of an A-tier athletic therapist as well, to advise with regards to preventative measures as part of a training programme is an area that is evolving and will continue to evolve as we move forward. It is strong in the States, and I think it is going to get stronger here as well. It will always be there, but it is incumbent on us to minimise that risk going forward.”

UPMC Completes Acquisition of Renowned UPMC Sports Surgery Clinic in Dublin

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UPMC announced today that it has formally acquired the renowned UPMC Sports Surgery Clinic (SSC) in Dublin, following approval by the Competition and Consumer Protection Commission (CCPC). SSC now becomes UPMC’s fourth hospital in Ireland, joining UPMC Whitfield in Waterford, UPMC Kildare in Clane and UPMC Aut Even in Kilkenny, along with sports medicine, cancer and outreach facilities across Ireland.

Ray Moran SSC Eamon Fitzgerald UPMC
Mr Ray Moran, Medical Director at SSC and Eamon Fitzgerald, Managing Director UPMC Ireland.

“The addition of SSC positions UPMC as an all-Ireland network of care and builds upon our commitment to clinical excellence since establishing our first cancer centre here in 2006,” said David Beirne, senior vice president of UPMC International. “This acquisition is just the latest expansion of UPMC’s clinical care in Ireland and complements our existing network of orthopaedic care in the U.S. and Europe, ensuring that we can provide access to care for more patients, close to home.”

“With the acquisition of UPMC Sports Surgery Clinic, UPMC Ireland has added a world-class facility to our network, strengthening our ability to provide advanced orthopaedic care to patients across the country, from facilities in Waterford, Kilkenny, Kildare, and now Dublin,” said Eamonn Fitzgerald, managing director, UPMC Ireland. He continued, “The addition of this facility, as well as the ability to align the sports medicine offering to our growing Ireland network, allows us to offer a seamless continuum of care, from diagnosis through to rehabilitation, and further cements our commitment to providing the highest quality healthcare services to the communities we serve.”

“Our global connections enable us to share the best ideas and clinical practices from around the world with the patients we serve, and I am excited to work with the team in Ireland and look forward to amplifying and advancing our orthopaedic service line into the future through cutting-edge care and innovation” said MaCalus V. Hogan, M.D., MBA, Chair of Orthopaedic Surgery at UPMC.

Founded in 2007 by orthopaedic surgeon Mr. Ray Moran and accredited by The Joint Commission International, the 101-bed SSC has become a centre of excellence for joint replacement and surgery for sports-related soft tissue injuries in Ireland. SSC has more than 40 consultants in orthopaedic surgery and allied specialties, supported by a team of more than 400 nurses, physiotherapists and other healthcare professionals.

“We welcome formal approval from the CCPC and are excited to join forces with UPMC to bring together our like-minded and innovative teams to provide care to even more patients across Ireland,” said Moran. “This acquisition will allow us to continue to provide the same high-quality service our patients have come to expect, while also benefiting from UPMC’s extensive resources and expertise. We look forward to working with UPMC to build on the UPMC Sports Surgery Clinic’s legacy of excellence and innovation.”

Why does Ireland have such a high rate of ACL injuries?

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Why does Ireland have such a high rate of ACL injuries?

Professor Brian Devitt is a Consultant Orthopaedic Surgeon at the UPMC Sports Surgery Clinic in Santry and a Professor of Orthopaedics and Surgical Biomechanics at Dublin City University.

This interview with Professor Brian M. Devitt was published on RTE’s Drivetime on 20th February 2023.

Professor Brian M Devitt SSC

For further information on ACL Injuries and Reconstruction or to make an appointment with an Orthopaedic Surgeon, please email info@sportssurgeryclinic.com

What is the Anterior Cruciate Ligament ?

The rate of Cruciate Ligament injuries in Ireland is among the highest in the world, which could be down to the types of sports commonly practised here. Brian Devitt is a Consultant Orthopaedic Surgeon at UPMC Sports Surgery Clinic in Santry and also a Professor of Orthopaedics at DCU. He’s been researching this area, and he joins us now, you are very welcome Brian (BD)

Just for those who don’t know what is the cruciate ligament and why is it so important?

BD: We have two Cruciate Ligaments, one is the anterior one at the front of the knee, and we also have the posterior one at the back of the knee.

The Anterior Cruciate Ligament (ACL) is the most commonly injured of the two, and it is only a 3.7cm ligament, but it is very important in sports because it controls rotation and stops our shin bone from moving forward in relation to our femur, side bone, so potentially it is a career-ending injury or at least it used to be anyway, but it certainly can cause a lot of damage in the knee when injured.

Is it easy to Injure your ACL?

BD: It is surprisingly easy, and that’s the problem; it tends to happen with non-contact injuries. So it is not when someone is being tackled, for instance, or trying to evade an opponent but more as ‘pivoting’, which means moving quickly in one direction.

Seven out of ten times, it occurs as a non-contact mechanism.

It isn’t usually an injury that you would associate with athletics or racing where you are just running in a straight line it is more where you are stopping, starting, turning and twisting types of sports?

BD: Yes, that is exactly right, a lot of those sports tend to involve a ball and particularly in the sports that we play in Ireland, the ball tends to be above the eye line so you tend to be focusing on the ball and catching it and then an opponent is tackling you, or you try to evade them so your eye line and your ability to move quickly can change.

Q: So what are we talking about here GAA, Hurling, Rugby and maybe Soccer as well?

BD: Yes Soccer actually has a very high basis of ACL injury, so all these kinds of ‘pivoting’ sports as we referred to already and really they make up the majority of team sports we play in Ireland.

As a result of that our rates in terms of cruciate injuries are amongst the highest in the world that’s directly related to the fact that we have this love for GAA, soccer and rugby too?

BD: Yes, and it is hard to get a really good number on the injuries. A lot of countries, particularly in Europe and New Zealand, have registries where we can look and get a good idea of the number of people who are injured.

So we have different sports that run data surveillance like GAA and rugby, so we can get a picture of how common the injury is. Certainly, our levels would be equivalent to the likes of Australia, where they play similar types of sport.

You mentioned it used to be career ending, less so now - what happens now if you get a cruciate ligament injury?

BD: So it all depends on the age of the patient, really, people that are slightly older, maybe in their forties perhaps, we can treat these injuries non-operatively.

But for young patients, we tend to recommend ACL Reconstruction, particularly if they have any other damage within their knee.

The idea is you need to control the rotation in the knee and give that patient a stable knee. So we can’t repair them; they tried doing that in the past with very dubious results.

So now we have to reconstruct the ligament by tacking a graph typically from the patient themselves.

Q: That sounds like quite an involved treatment, quite a serious surgery?

BD: It is a serious surgery, we have refined the surgery over the years, so it is not the career-threatening injury it used to be.

Our techniques and our ability to diagnose ACL injuries have certainly improved and nowadays, it is a pretty routine surgery for us.

The prognosis for the patient or how they are going to do in the future is not just based on their injury of the ACL but also to the other important structures that are in the knee, such as the cartilage or shock absorbers which we refer to as the meniscus. This really determines how a patient does in the long term.

There is also an increase in women being diagnosed with ACL injuries?

Q: There is also an increase in women being diagnosed with ACL injuries, I know we were doing a programme a couple of months ago on this and it is partly linked to the footwear women have been wearing, because the footwear woman wears in sports is designed for men and doesn’t take into account the different weight of women. etc., and the different ways they move.

Is that something you will be seeing as well, women are playing more sports also and women are being diagnosed with more ACL injuries?

BD: Yes, I think it is a multifactorial reason as to why women tend to create quite a risk in certain sports, but what we are certainly seeing is a greater level of participation of women, so therefore, we are seeing the rates increase in terms of the number of women presenting to us for reconstruction, definitely increases.

I think there was a very worrying trend in Australia, where I was working for the last eight years, where they have seen a huge epidemic of ACL injuries, particularly in the young female population, from the ages of twelve right up until eighteen.

I think similarly in Ireland we have more organised sports at a young age, particularly for girls and young women. Therefore our rates are increasing

If you’re listening and you have children involved in sports, like the sports you have mentioned. What do you do to try reduce the chances of them getting an ACL injury?

BD: Well, the great thing is a lot of the sporting bodies that I have mentioned have fantastic initiatives in place to try to reduce the rates of injuries. I think initially they are referred to as injury prevention strategies, but really, we can’t prevent injuries but just reduce the risk.

These warm-up exercises have been shown to reduce the rate of injuries by up to fifty per cent, and they are included as part of a warm-up in GAA fifteen, FIFA Eleven and Rugby have an equivalent warm-up technique.

If you’re to do anything, it is to encourage your children and also their coaches to get involved in this warm-up because they are really very effective.

Q: Ok, so the warm-up really matters then? It’s really important?

BD: Absolutely, it matters.

Q: Is it something that children have a bit more resilience against? they are a bit more bouncy to use a non-medical term.

BD: They can be bouncy at younger ages, but what we typically see is when they become less bouncy as they get to the adolescent stage, they are probably at increased risk.

Also, once they have had  ACL surgery, there is quite a risk of re-injuring the same ACL even though they have been reconstructed but also injuring the contralateral or opposite leg.

This is a group we really focus on. We refer to them as high-risk groups, so whereas we can try to mitigate and reduce the rates of injury when we have patients that have sustained these injuries, we have to think quite clearly in terms of how we reconstruct them and if it is efficient alone to do an ACL reconstruction or do we have to do something else to try to reduce the rates after surgery.

Alright, it was great speaking to you that was Brian Devitt, Consultant Orthopaedic Surgeon at the UPMC Sports Surgery Clinic in Santry.

‘Ireland’s rate of ACL injuries among highest in the world because of GAA and rugby’ Professor Brian M Devitt

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Leading surgeon points to alarming number of injuries here as competitors push their bodies further

This article was published in the Irish Independent on 20th February 2023.

 

Professor Brian M Devitt Consultant Orthopaedic Surgeon at SSC in Santry.

A leading surgeon has said the incidence of anterior cruciate ligament (ACL) injuries in Ireland is among the highest in the world, as sports popular here have a high risk for the injury.

Brian Devitt, a consultant orthopaedic surgeon at the UPMC Sports Surgery Clinic in Santry and Professor of Orthopaedics and Surgical Biomechanics at Dublin City University, said he is also seeing more ACL injuries as the number of women taking part in sport is on the rise.

“In GAA, hurling and rugby, the ball is often played overhead, above a player’s eye-line,” Prof Devitt said.

“When a player is fielding a high ball, landing, and trying to avoid an opponent by pivoting, there is a lot going on which requires huge co-ordination. Unfortunately, when this co-ordination fails, even momentarily, it can put the knee at risk of giving way, and that’s why there’s a high rate of ACL injuries here.

“There are lots of times during a match when players aren’t aware of how they are landing when trying to catch the ball. An injury can happen in a microsecond, and that’s especially true for the sports we love in Ireland,” he added.

When the ligament pops or snaps, it may require surgical reconstruction as it has a limited capacity to heal.

“The ACL controls the forward motion of the knee and also, most importantly, rotation. If you are changing direction, such as side-stepping, then your ACL is working. In the majority of cases – roughly 70pc – ACL injuries occur without contact with an opponent.

“A rupture typically happens when a player is pivoting, or changing direction at speed.

“The other reason we are seeing such a high incidence of ACL injuries in Ireland is because the level of female participation in sports is surging, which means we are seeing comparable ACL numbers now in women.”

The source of the trouble, the ACL, is a 3.5cm piece of connective tissue which links the shin bone to the thigh bone, located in the middle of the knee.

When the ligament pops or snaps, it may require surgical reconstruction as it has a limited capacity to heal. This is especially recommended in young, active individuals returning to a pivoting sport.
ACL reconstruction surgery is reasonably routine, but it can be complex if there is additional cartilage damage.

There is no guarantee of success, particularly in young patients, who are high-risk.
“It is tragic when an ACL reconstruction fails, and, unfortunately, we do have higher failure rates than we would like in our younger population,” Prof Devitt said.

‘In GAA, hurling and rugby, the ball is often played overhead, above a player’s eye-line,’ Prof Devitt said.

“We understand some of the reasons for this, but not all. This is one of the questions I would like to address in my clinical research.”

Prof Devitt went to school at Belvedere in Dublin’s north inner city, where he excelled academically and in sport, playing rugby for the school team. He studied medicine at UCD, and continued to play rugby.

“Given how much I was involved with sport, it seemed like a natural progression to head for a career that would involve sport, and orthopaedic surgery was the ideal speciality for me,” he said.
After UCD, he completed his orthopaedic training at the Royal College of Surgeons in Ireland, before heading overseas on a fellowship in the US, Canada and Australia.

My research is looking outside the knee for new solutions – not simply doing a reconstruction of the ACL, but a procedure outside the knee.

He also found time to raise a family with his wife Marina, with whom he has three children, aged 10, eight and six.

“We have the unique distinction of having three children, all born on different continents. As such, our children all have at least three passports,” he said.
He decided to return home last year, when he accepted a role where his time would be divided between clinical work at the Santry clinic and research at DCU.

Since returning he has been staggered by the number of ACL injuries coming through his clinic door.

“I worked at a hospital in Melbourne for a number of years, and saw a lot of ACL injuries – which was not a surprise given how devoted the Aussies are to sport,” he said.

“Ireland though is totally bonkers about sport, and the volume of ACL injuries I’m seeing in Santry certainly surpasses the numbers I experience in Melbourne.”

He sees injury reduction as a big part of his new role, and he does not want to be a surgeon interested only in treating injuries.

“An ACL injury is traumatic for the person who suffers it, and it can increase the risk of earlier onset of arthritis,” he said. “A successful reconstruction of the ligament can get someone back playing sports and perhaps delay the onset of arthritis later in life, though we can’t prevent it.

“A big research question for me is how we can reduce ACL injuries as we will never be able to totally prevent them from happening.

“My research is looking outside the knee for new solutions – not simply doing a reconstruction of the ACL, but a procedure outside the knee. We want to improve our surgical techniques, and also to use biomarkers, which can hopefully inform us about who is at great risk for arthritis.”

For further information on ACL injuries or to make an appointment with an Orthopaedic Surgeon specialising in knee Injuries, contact info@sportssurgeryclinic.com
UPMC Sports Surgery Clinic Orthopaedic Hospital

UPMC to Acquire UPMC Sports Surgery Clinic

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UPMC Sports Surgery Clinic in Santry to become part of renowned global care network.

DUBLIN, 16th January 2023 – In a move that will dramatically expand UPMC’s ability to provide world-class orthopaedic and sports medicine care in Ireland, the health system today announced that it is acquiring the renowned UPMC Sports Surgery Clinic (SSC), a leading independent hospital located in the northern Dublin suburb of Santry.

Well-known for its care of patients and athletes across Ireland and Europe, SSC will become part of UPMC’s network of orthopaedic, sports medicine and rehabilitation facilities, and will also become UPMC’s fourth hospital in Ireland, joining UPMC Whitfield in Waterford, UPMC Kildare in Clane and UPMC Aut Even in Kilkenny, along with sports medicine and outreach facilities across Ireland.

“With the acquisition of the UPMC Sports Surgery Clinic, we will have the ability to expand our already trusted and high-quality care to more patients across Ireland and beyond,” said Charles Bogosta, president of UPMC International. “SSC will complement our existing network of orthopaedic care in the U.S. and Europe and ensures that we can provide access to care to more patients, close to home.”

Founded in 2007 by orthopaedic surgeon, Mr. Ray Moran, and accredited by The Joint Commission International, the 101-bed SSC has become a centre of excellence for joint replacement and surgery for sports soft tissue injuries in Ireland. The SSC currently has more than 40 consultants in orthopaedic surgery and allied specialties, supported by a team of more than 400 nurses, physiotherapists and other health care professionals.

Commenting on the agreement, Mr. Ray Moran, said: “This is an exciting development for all of us involved with UPMC Sports Surgery Clinic and we are delighted to be joining forces with UPMC. It brings together like-minded and innovative teams whose combined experience and expertise will benefit the patients that we serve.” He continued: “We look forward to working with UPMC to build on the legacy of excellence and innovation that the UPMC Sports Surgery Clinic has established as we expand the scope and location of our services for the benefit of patients.”

“The addition of SSC will position UPMC as an all-Ireland network of care and builds upon our commitment to clinical excellence since establishing our first cancer center here in 2006,” said David Beirne, senior vice president of UPMC International. He continued, “This pending acquisition is just the latest expansion of UPMC’s clinical care in Ireland. In addition to the current three hospitals and concussion network, UPMC operates two advanced radiotherapy centres, three sports medicine clinics and several outpatient facilities across the country.”

UPMC’s acquisition of SSC is subject to approval by Ireland’s Competition and Consumer Protection Commission. Terms of the purchase are not being disclosed.