Dr Lingaraj is an experienced orthopaedic surgeon, who subspecializes in knee and hip surgery, as we
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This beautiful Rangoli decoration was prepared by the staff of Gleneagles Hospital to herald the start of the Deepavali long weekend. The team at Orthopaedic and Hand Surgery Partners would like to take this opportunity to wish everyone a very happy Deepavali and a happy long weekend!
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The meniscus is a small rubbery, C-shaped disc that cushions the knee. Despite its diminutive size, it is actually a very important part of the knee. It functions as a shock absorber and also helps to maintain stability within the knee.
In fact, its importance is underscored by the fact that the inaugural Meniscus Asian Summit was held in Seoul on 5-6 October just to discuss the latest in basic science, assessment and treatment of disorders of the meniscus.
The Summit brought together orthopaedic surgeons from Asia and Europe, and provided a tremendous opportunity to learn and share.
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In conjunction with World Physiotherapy Day, the Parkway Rehab Team conducted a Workshop today that focused on improving outcomes for patients who have undergone ACL reconstruction surgery.
I was delighted to be involved in this workshop together with Mick Hughes, a physiotherapist and exercise physiologist from Melbourne, and author of the widely-followed Melbourne ACL Rehabilitation Guide. I spoke about surgical, rehabilitation and psychological strategies to improve patient outcomes after ACL reconstruction surgery, while Mick conducted practical training on pre-operative and post-operative rehabilitation.
A lively discussion followed the talk, which involved participants physically present at the meeting in Singapore and their counterparts watching the live-stream of the event in Malaysia, China, India and Turkey.
Kudos to Sahayog Sahay and the organizing committee for putting together an excellent program!
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Today is World Physical Therapy Day! I’d therefore like to take this opportunity to thank all of my physiotherapy friends and colleagues for being an integral part of the care team for our patients.
Diagnosis, medical treatment and surgery are just one part of the care process. Rehabilitation is a crucial component of the recovery journey, and it would not be possible without physiotherapists providing patients with guidance, encouragement and care during their journey.
In conjunction with World Physiotherapy Day, the Parkway Rehab Team is organizing a 2-day Physiotherapy Workshop. I’m delighted to be involved in the first day of the workshop which deals with Improving Outcomes in Anterior Cruciate Ligament (ACL) Reconstruction Surgery. I’m certainly looking forward to it!
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I planted a tree for the first time today! It was hard work, but certainly an enjoyable and meaningful activity.
Together with my friends, schoolmates and teachers, we gathered at Bishan Park to plant 50 trees as part of Raffles Institution’s 1823 Trees Campaign. This was in support of the National Parks Board’s (NParks) OneMillionTrees movement and a component of RI’s bicentennial celebrations.
The OneMillionTrees movement aims to restore nature back into our city through the planting of more than a million trees across Singapore, and is part of NParks’ efforts to transform Singapore into a City in Nature.
Had great fun at the National Stadium yesterday watching the game between Liverpool and Bayern Munich yesterday! The atmosphere was electric and the fans were in their element. Most importantly I managed to catch up with good friends and fellow fans😅
Too bad my team lost but I’m sure we’ll do better the next time!
I was honoured to be invited to speak at the combined meeting of the Thai Orthopaedic Society for Sports Medicine (TOSSM), the ASEAN Society for Sports Medicine and Arthroscopy (ASSA), and the Korean Shoulder and Elbow Society (KSES), which was held in Pattaya, Thailand from 6-8 July.
I spoke about the management of knee meniscal tears and ACL injuries. More importantly, I had the opportunity to reconnect with my friends and colleagues from the region!
Congratulations to Prof Bancha and the TOSSM Organizing Committee for putting together an excellent program and meeting!
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It was an absolute honour to be a part of Raffles Institution’s 200th Founder’s Day celebrations earlier today. I would like to thank the organizing committee for inviting me to present the Stamford Raffles Award (Year 6) to this year’s winner Ms Chua Jean Ee. It was an award that I received many eons ago in 1991.
The intent behind each award being presented by a past recipient to a current recipient was to continue the legacy of achievement and contribution to society from past to future generations of Rafflesians.
It was a privilege to be educated at RI, and I am sure I speak for my fellow Rafflesians when I say that the school has been integral in shaping who we are today. This is due to the many dedicated teachers who guided and encouraged us during our time there, the friendships we forged then and cherish today, and the giants from past generations of Rafflesians on whose shoulders we stand today.
Earlier this week I contributed to an article in the Straits Times on the relative differences between women and men in the areas of exercise needs, sports injuries and other orthopaedic injuries.
The three take-home messages are as follows:
1. There are no differences in exercise needs between men and women, except for women who are pregnant or have just delivered.
2. Yes, women are more prone to certain types of sports injuries than men. For instance, they are up to 8 times more likely to sustain anterior cruciate ligament (ACL) injuries in the knee. This may be due to anatomical and hormonal differences.
3. As women get older and reach menopause, they are also more likely to develop osteoporosis. This makes bones more brittle and more likely to fracture with even minor injuries. Weight-bearing physical activity has been shown to improve bone density and reduce bone loss. Therefore it is especially important for women to exercise regularly to prevent osteoporosis.
https://www.straitstimes.com/life/the-bottom-line-do-men-and-women-need-to-train-differently-for-fitness
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I’m delighted to share that his week marks the third anniversary of Orthopaedic and Hand Surgery Partners!
Time has certainly whizzed by and it’s been a wonderful and fulfilling journey for all of us. The next 3 years are going to be equally exciting as we work towards growing and expanding our practice. So watch this space!
We are blessed indeed to have the amazing support of our patients, colleagues and families, as well as Gleneagles Hospital and Mount Alvernia Hospital, without which none of this would have been possible.
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At Orthopaedic and Hand Surgery Partners, tele-consults allow us to provide continuity of care for local patients in the comfort of their homes, for Singapore residents who are overseas due to work or study, and for foreign patients who have returned home.
In general, first visits are conducted face-to-face in the clinic setting. However, subsequent reviews may be carried out via tele-consults. During these reviews, the results of imaging and other investigations can be explained, treatment options can be discussed, and responses to treatment can be assessed. Prescriptions, medical certificates and memos can also be issued electronically.
Take the case of Nitasha who recently returned to the UK for her undergraduate studies. The above tele-consult allowed us to provide her with ongoing care and follow-up even though she’s thousands of kilometers away!
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I was delighted to catch up with friends, colleagues, mentors and students at the celebratory dinner of the 70th Anniversary of the NUS Department of Orthopaedic Surgery.
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I’m happy to share that Orthopaedic and Hand Surgery Partners has introduced an online appointment booking system for patients.
This will add further ease and convenience to the process of accessing our clinical services.
Patients can also reach us via phone, SMS, email, and WhatsApp.
https://clinic.platomedical.com/book/b3J0aG9oYW5kcGFydG5lcnM=/096ae9835e514654b211bbad08ef270f
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I’m happy to share an article that I wrote on knee meniscus injuries. It was recently published in the August-September 2022 issue of Prime Magazine.
The article talks about the anatomy and function of the meniscus, how injuries to the meniscus are diagnosed, and the different ways in which such injuries can be effectively treated.
The take-home message is that meniscal tears are critical injuries within the knee. It is important that they are evaluated and treated early by an experienced sports orthopaedic surgeon, so as to achieve the best possible outcomes.
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I was delighted to be on The BIG Show on One FM 91.3 with Angel, FD, Glenn and Shaun on Wednesday 6 July.
With cycling, running and HIIT emerging as popular 'pandemic sports', and the recent resumption of ‘pre-pandemic’ sports like soccer and basketball, Singapore has seen a recent increase in knee injuries.
We talked about common knee sports injuries and the basics of managing them effectively.
The key take-home messages were:
1. Prevention is better than cure.
2. If these injuries do develop, it is important to seek treatment early.
Here’s the podcast:
https://omny.fm/shows/onefm913-good-morning-doctor/sports-injuries-on-your-knees
Here’s a recording of the FB Live session:
https://fb.watch/e4yylu7nHB/
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This weekend marks the second anniversary of Orthopaedic and Hand Surgery Partners. And what a journey it’s been!
We officially opened our doors on 2 April 2020. But just 5 days later, Singapore entered a 2-month Circuit Breaker. It was certainly not the best time to start a new clinic! What followed were 2 years of ups and downs - mirroring the twists and turns that everyone faced during the Covid pandemic. However the journey went on, and we adapted and kept working hard.
We would not be where we are today if not for the amazing support of our patients and staff over the past 2 years. Here’s looking forward to many more years of excellent patient care and service.
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Today I’d like to remember and honour Prof Bala - a gentleman that many of us in the orthopaedic community in Singapore and the region know.
Like many generations of Orthopaedic trainees before me and after me, I first got to know Prof Bala during our weekly evening tutorials at his home in the lead-up to the FRCS exams. Each tutorial was meticulously planned, and over the course of several months, he would cover the entire breath and depth of Orthopaedic surgery. His dedication to teaching and training was not just confined to Singapore - it extended to the wider South East Asian community, including Malaysia and Indonesia.
In the years that followed, he was not only my teacher, but also a mentor, inspiration, role model and friend. He was generous, warm, humble, caring, perceptive and supremely intelligent.
Thank you Prof Bala for all that you’ve done. You will always be remembered.
I had the privilege of participating in a hands-on workshop on knee replacement surgery using robotic technology recently. Continuing education is an essential part of medical practice, and attending courses such as these allows one to keep abreast of the latest techniques and developments in orthopaedic surgery. Special thanks to Dr Darren Tay and Stryker for organizing an excellent course.
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Here’s wishing you Happy Holidays and a wonderful new year!
I had the pleasure of moderating a session on Multi-Ligamentous Knee Injuries at the recently concluded annual scientific meeting of the ASEAN Society for Sports Medicine and Arthroscopy (ASSA) and the Philippine Orthopaedic Society for Sports Medicine (POSSM). The organizers (in particular Dr Rich Pasion, Dr Tony San Juan and Dr Gar Eufemio) should be congratulated for putting together an excellent meeting.
It was wonderful to meet up with old friends again, even though it was online. Virtual meetings have transformed the landscape of scientific sharing and collaboration, and allowed for the continuity of learning in the midst of Covid.
However, nothing beats the interaction and camaraderie of a face-to-face meeting. Hopefully next year brings us closer to this reality.
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New clinic branch at Mount Alvernia Hospital
I am delighted to share that David Tan, Sandeep Sebastin and I at Orthopaedic and Hand Surgery Partners have opened a new clinic branch at Mount Alvernia Hospital.
It is located at: #06-08 Medical Centre A, Mount Alvernia Hospital, 820 Thomson Road, Singapore 574623. (Tel: 6261 0235 / Mobile and WhatsApp: 8027 7255)
The new clinic will enhance our accessibility to patients and widen the geographical footprint of our practice.
Together with our staff, we will continue to provide the highest standards of clinical care and service.
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I was interviewed by the Straits Times recently about common sports injuries affecting women. These include acute traumatic injuries, such as anterior cruciate ligament (ACL) tears and patella (kneecap) dislocations, and chronic overuse injuries, such as patellofemoral pain syndrome (runner’s knee) and shin splints.
Most women seek medical attention early for their injuries. This is because there is currently greater awareness of sports injuries and their treatment. Many women actively seek to find out more about their injuries from their healthcare providers, from family and friends who may have suffered similar injuries, and from patient education resources that available on the internet.
Unfortunately, a few women do put off getting their injuries evaluated, mainly because of the competing demands of work and family, which may make it difficult for them to seek medical attention early. This may lead to worsening of the injuries by the time they come for treatment.
Effective treatment is certainly available, and the potential for excellent recovery is greater when injuries are treated early rather than late.
https://www.straitstimes.com/singapore/health/feeling-pain-after-a-workout-dont-just-ignore-it
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If that pain or soreness isn’t going away even weeks after your last spin class or Zumba workout, you might want to seek medical attention as soon as possible.. Read more at straitstimes.com.
Knee Meniscus Tears
Many patients present to the Orthopaedic clinic with knee pain caused by meniscus tears.
Prior to the onset of their symptoms, these patients may have participated in exercises such as running and high-intensity interval training.
The meniscus is a rubbery, C-shaped disc that cushions the knee. Each knee has two menisci - one at the outer edge of the knee (lateral meniscus) and one at the inner edge (medial meniscus). The menisci function as shock absorbers in the knee and also help to maintain stability within the knee.
MRI scans are done to confirm the diagnosis. The picture below shows what a tear of the meniscus looks like on an MRI scan.
Patients with small meniscus tears may be treated non-surgically with a course of rehabilitation. However, in other patients, early surgical treatment is needed to repair the meniscus and maintain its proper function within the knee.
An early Orthopaedic review would help to clarify the optimal treatment option.
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I was delighted to speak to the students and faculty of the College of Alice and Peter Tan on 6 September as part of the Master’s Tea Series organized by A/Prof Gary Tan and Zhang Zhe Xin.
Together with Jansen Lee and Derek Lee from PhysioX, we discussed the importance of patient-centredness in healthcare, particularly with regards to the management of sports injuries.
The crucial point of the talk was that patients must be the focus of the healthcare system, and that they should be actively involved in the decision-making process. They should also empower themselves by seeking knowledge regarding their condition from reliable sources. A lively question and answer session followed the talk.
This was my first face-to-face talk in more than a year, and it was refreshing indeed to talk to people in person, rather than through a computer screen. Safe distancing protocols were reinforced amd adhered to throughout the talk.
Special thanks to Prof Tan and Zhe Xin for this wonderful opportunity!
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What an inspiration she is to her fellow athletes and all Singaporeans!
https://www.channelnewsasia.com/sport/yip-pin-xiu-gold-tokyo-paralympics-swimming-50m-backstroke-s2-2151911
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SINGAPORE: Singapore's Yip Pin Xiu won gold in the women’s 50m backstroke S2 final at the Tokyo Paralympics on Thursday (Sep 2). She clocked a time of 1:02.04 at the Tokyo Aquatics Centre, successfully defending the title she won in Rio in 2016. She has also set a new season best record.
Of all the stories of triumph that have come out of the Tokyo Olympics, the one that has touched me the most is that of Hidlyn Diaz from the Philippines. She won the gold medal in the women’s 55-kilogram weightlifting competition.
Diaz spent more than a year away from her family training in Malaysia after being stuck due to Covid-19 restrictions. At one point, she had to continue her training in a makeshift facility in a car porch because all the gyms were closed.
Her story is one of dedication, perseverance, excellence, and overcoming the odds. What an inspiration!
https://www.channelnewsasia.com/news/asia/how-hidilyn-diaz-made-olympic-history-philippines-gold-medal-15303856
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Triumphant weightlifter Hidilyn Diaz will now forget the years of exile, sacrifice, training and nutrition that took her to the Philippines' first ...
This has been a tough Olympics for Team Singapore athletes. However, they should be applauded for their sacrifice and hard work in preparing for the Games in such difficult circumstances, and for doing their best in Tokyo.
Loss is part of sport, as much as it is a part of life. With determination, perseverance and hard work, this experience can serve as a foundation for future success.
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Today August 1st is Nurses Day in Singapore. On this day, we honour and recognize the contribution of nurses to the health and well-being of our nation. Singapore is perhaps the only country in the world that celebrates Nurses Day on 1st August instead of 12 May, which is the birthday of Florence Nightingale. This is because 1 August 1885 was when the development of nursing began in Singapore. That was the day a call for nurses was answered by nuns from the local French Convent, who started nursing at the General Hospital at Sepoy Lines.
I’d like to make special mention of Charmaine, who is our nurse at Orthopaedic and Hand Surgery Partners. Together with Nor, Annabel and Fara, she exemplifies the virtues of empathy, compassion and professionalism, which are the hallmark of nursing. During my career, I’ve been blessed to work with and get to know many nurses who have epitomized these values. To all my nursing friends and colleagues, Happy Nurses Day!
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I’m happy to share that I’ve joined Wei Ling Low and her team at Vanda Global Capital as a Knowledge Depth Specialist in Med Tech, Health Tech, Orthopaedic Surgery and Sports Medicine. Looking forward to a fruitful collaboration!
https://vandaglobalcapital.asia
I’d like to share that I’ll be giving a talk as part of Tanglin Community Club’s Online Series on ‘Dealing with a Musculoskeletal Epidemic in the Midst of Covid’ on 28 July 2021. Please do join in!
You can register at the link below. The closing date for registration is 27 July 2021.
https://go.gov.sg/tcctalk28july
I am happy to share an article that I wrote recently for Prime magazine. It talks about arthritis of the knee - a common condition affecting millions of people the world over - and explains what one can do to overcome it.
https://prime.sg/going-weak-at-the-knees/
Osteoarthritis of the knee and what to do about it Ever heard someone around you complain about a painful, swollen or stiff knee? You may have encountered your friends and/or family members bring up the subject of “osteoarthritis” and may also have started to wonder what the fuss is all about. S...
The Euro 2020 soccer tournament is reaching its climax with the final between Italy and England to be played this Sunday. While the final is certainly capturing headlines, the injuries suffered by players during the tournament are less well-reported. Soccer is called ‘the beautiful game’ for good reason. However, injuries do sometimes occur, and these can occasionally be
serious.
In the round-of-16 clash between Ukraine and Sweden, the Ukrainian striker Artem Besedin suffered a serious injury to his knee. Looking at the footage of the incident, it is likely that he sustained a multi-ligamentous injury. As the name suggests, this injury affects 2 or more of the 4 main ligaments which stabilize the knee. These are the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and the lateral collateral ligament. In their most serious form, multi-ligamentous injuries involve a dislocation of the knee.
Multi-ligamentous knee injuries usually require early surgery. While in the past, such injuries would have been career-ending, with modern reconstructive surgical techniques, there is now a reasonable prospect of returning to competitive sporting activity. Here’s wishing Artem a swift recovery!
https://www.independent.co.uk/sport/football/ukraine-england-dynamo-kiev-sweden-mri-b1875510.html
A late goal in extra time saw Andriy Shevchenko’s side through to face England in Rome
Many of us are following the Euro 2020 soccer tournament with great excitement and anticipation. There have already been several classic games like the recent clash between Belgium and Portugal.
What may be less apparent is how intensely sports science guides the management of players and teams in soccer and other sports at the elite level. Sports science refers to the detailed study of biomechanics, human physiology, nutrition, and psychology, and their application to training, performance maximization and competitive play.
Success at the elite international level is as dependent on raw talent, as it is on the rigorous application of scientific principles to training and performance.
Closely intertwined with sport science is the field of sports medicine, which deals with the prevention, diagnosis, treatment and rehabilitation of sports-related injuries.
Today every successful elite sports person or team is supported by highly sophisticated sports science and sports medicine teams.
Knee Arthroscopy
The French Open tournament ended last Sunday with Novak Djokovic winning the final against Stefanos Tsitsipas. Unfortunately Roger Federer had to pull out of this year’s tournament because he had recently undergone a knee arthroscopy procedure on his right knee.
What is knee arthroscopy? It is a surgical procedure that allows doctors to view the inside of the knee joint by inserting a small camera called an arthroscope through very small incisions in a minimally invasive manner. Compared to open surgery which involves larger incisions, arthroscopic surgery results in less pain, less joint stiffness, and a faster recovery.
Arthroscopy can be used to treat a wide range of knee conditions, including meniscus tears, cartilage injuries and ligament tears.
https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/
During knee arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your knee joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments.
Tomorrow is the final of the UEFA Champions League between Manchester City and Chelsea. It is a match that I am sure many of us are looking forward to.
Something that is less well known is that at least one member of each team’s squad has had a previous anterior cruciate ligament (ACL) injury in the knee. They include Benjamin Mendy (Man City) and Kurt Zouma (Chelsea).
ACL injuries are potentially career-threatening injuries. However, with effective surgical treatment and post-operative rehabilitation, players can return to the highest levels of competitive soccer.
https://www.drlingarajkrishna.com/acl-reconstruction
To follow up from my previous post, the second musculoskeletal issue that has increased in prominence with work from home (WFH) arrangements is that of exercise-related injuries.
A recent survey conducted by Ipsos showed that 40% of people in Singapore were exercising more during the current Covid pandemic. This is probably due to WFH arrangements giving greater flexibility with work schedules and therefore more time for exercise. Popular forms of exercise include running, cycling and high-intensity interval training (HIIT).
This has led to an increase in both acute traumatic and chronic overuse injuries affecting joints such as the knee and shoulder, as well as tissues such as muscles and tendons.
Acute traumatic injuries include fractures, ligament injuries and muscle tears. Chronic overuse injuries are the result of repetitive stress to tendons. muscles and joints, and are usually due to increasing training intensity and volume too rapidly. An example would be patellofemoral pain syndrome or runner’s knee.
Mild injuries may be treated with rest, painkillers and physiotherapy. However, more severe injuries may need to be assessed and treated by an orthopaedic surgeon.
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The recent tightening of Covid restrictions has meant that many of us have returned to work from home (WFH) arrangements.
WFH arrangements have in the past inadvertently led to 2 types of musculoskeletal issues. I’ll talk about the first of these here - that of an increase in the number of neck and back-related complaints.
The reasons for this are the long periods spent maintaining fixed postures of the neck and back, sometimes in settings that may not be ideal work stations such as the dining table or bed. These settings can lead to the adoption of ergonomically poor body postures which involve excessive forward bending of the neck and back.
The above factors lead to fatigue and strain of the muscles that hold the neck and back in that position. Also the forward bending position leads to increased pressure within the intervertebral discs of the spine in the neck and lower back. These in turn can lead to symptoms such as pain and stiffness in the neck and back, as well as pain radiating to the arms and legs.
Prevention is better than cure, and there are 3 simple measures that can be taken to prevent the onset of these symptoms:
1. Get moving - move around and take a stretch break for 5-10 minutes for every hour spent at a workstation. This will help to relieve the strain in the muscles supporting the neck and back.
2. Maintain a good posture while working - aim for a neutral upright posture and avoid leaning forward, such that the ear is in line with the shoulders and hips. This will help to reduce the pressure within the intervertebral discs of the spine in the neck and lower back.
3. Exercise regularly - participate in a core muscle strengthening and spine conditioning exercise program that will help to maintain muscle endurance and prevent muscle strain and fatigue.
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