Leave no stone unturned when treating Tze Yong, says Dr Ramlan

New Straits Times

a day ago

KUALA LUMPUR: A concerted, comprehensive team effort involving everyone from the surgeon to the coach is needed to ensure national shuttler Ng Tze Yong makes a successful recovery after he undergoes anterior cruciate ligament (ACL) surgery.
That is the view of former National Sports Council chief executive officer Datuk Dr Ramlan Abd Aziz.
Tze Yong, who sustained the ACL injury during the recent Malaysia Masters, is expected to go under the surgeon's knife soon.
A BA of Malaysia official last week disclosed that Tze Yong had suffered "a complete ACL tear."
It is a disappointing blow for Tze Yong who has already undergone two procedures - including endoscopic spine surgery - as he battled back pain over the past year.
ACL injuries, which are relatively common in sports that require rapid direction changes such as football and badminton, have in the past been an athlete's worst nightmare.
Such injuries have ended athletes' careers or significantly diminished their sporting abilities to the point they are no longer competitive at the highest level.
But with advances in sports medicine and rehabilitation over the years, that is no longer the case and Dr Ramlan believes Tze Yong can come back stronger than before if he is guided correctly through the entire process.
The first step, he says, is to determine how the injury occurred and which areas of the knee have been affected.
"There are many factors to be considered before he undergoes surgery," said Dr Ramlan when contacted recently.
"We have to first understand the mechanism of the injury (how it happened). Was it due to one particular instance of hyperextension of the knee or was there perhaps a predisposing injury before?
"If there was a partial tear in the knee previously, it would have resulted in diminution - weakening in the muscles -surrounding the knee.
"If not spotted or addressed, it is essentially a ticking time bomb. Even a lesser instance of overextension or aggravation could cause a major episode.
"You then have to determine whether there has been associated tears within the structures of the knee (involving the posterior cruciate ligament, lateral collateral ligament, medial lateral ligament, lateral meniscus and medial meniscus).
"This is important for the surgeon to decide what needs to be done to ensure the knee can be restored to an optimum state.
"The common practice nowadays is to take a sliver of ligament from the hamstring tendon. This way there is no issue with rejection or infections.
"The surgeons nowadays are very good and have it down to a very fine science."
Dr Ramlan added that in the past ligaments were usually taken from cadavers or the patient's own infrapatellar tendon - underneath the knee cap - though this is no longer the case today.
The real work for Tze Yong, however, begins the moment the surgery is concluded.
Dr Ramlan stressed that Tze Yong must be mentally prepared to fight his way back to fitness during the rehabilitation process.
"After the operation there will have to be some wound care to make sure there are no infections, anything can happen, so this is important," said Dr Ramlan.
"Then, as soon as possible, he will have to work on early mobilisation, this is the principle nowadays. This is to minimise muscle wastage as much as possible and overcome stiffness.
"The athlete will probably be under the surgeon's physiotherapist (for conventional orthopedic rehabilitation) for the first two weeks but after that it is important to transition to sports (specific) rehabilitation which incorporates the basic principle of training in sports.
"It is important to strengthen the muscles around the knees and ensure there is balance between them because these muscles all work in tandem.
"Swelling is also expected during the first few weeks and there could also be post-exercise inflammation which can now be treated through cryotherapy.
"The athlete must be prepared for this psychologically because the whole process will take time. In my experience, young patients want to get better yesterday (are impatient). Patience and resolve from the patient is imperative."
Ramlan added that all parties involved in Tze Yong's rehabilitation process must work together hand in hand.
This is especially important considering Tze Yong had previously undergone two procedures on his spine.
"His attending doctor must get in contact with the surgeon who did the procedure for his spine and understand what the prognosis was. We have to get the facts right as we cannot afford to assume things," said Dr Ramlan.
"It is important all parties work together closely, this includes the surgeon who does the knee surgery, the surgeon who did the spine surgery, the physiotherapist, the strength and conditioning coach as well as the (player's own) coach as well as the association.
"The coach is the most important person when it comes to the rehabilitation process and must play an important role in overseeing the whole process.
"The athlete can start with isometric exercises (to strengthen muscles) and then progress to isotonic exercises which includes open and closed chain exercises when he is ready.
"Correct form is important. All this has to be monitored so there has to be strong cooperation from all parties because we (medical staff) cannot be with him all the time (once he has left hospital).
"If I am taking care of a national player and have high hopes of him playing in the Olympics, this is how it has to be done. I cannot afford to leave any stone unturned.
"The surgeon has already done his job but that is only 50 per cent of the story. He (surgeon) will not want his work to be undermined by shoddy work in the other 50 per cent (during rehabilitation)."
Ramlan said Tze Yong could return to sports-specific training in nine months after the surgery though this depends on various factors.
"It is important not to rush the process but at the same time we do not want to be going too slowly. This all depends on the judgement of the doctor in charge of the rehab process," said Dr Ramlan.
"There really is no fixed period where I can say one period (of rehabilitation) ends and one starts.
"However, I would be disappointed if we were not able to progress to some conditioning work by the fourth month and by the ninth month or so, he should be able to do some sports-specific conditioning work.
"This would mean he would be able to train on court with a programme specifically tailored for him."