Treating elite athletes: benefits to the general population

How do the general population benefit from you treating athletes?

Andy: So there is a big difference between treating the general population and elite atheletes. First of all it creates quite a challenge because there is an enormous pressure on getting these people back to the same level of activity they had before they were injured - and to do so at top speed. So, as quickly as possible.

So, I quite enjoy the challenge of dealing with them because it really tests me. But there's been a huge benefit to me, it’s a tremendous discipline, because I have to perform. And by improving my treatment, my judgement, my surgery and the post-operative rehabilitation, it does really help my general population patients, so there's a really good knock-on, from treating this group.

How has treating elite athletes improved ligament surgery outcomes?

Andy: If you think about it, if we didn't have the pressure to treat elite athletes, the quality of treatment available to the general population wouldn't be as good as it is. For example, say with anterior cruciate ligament surgery, it's come on hugely and its driven by the need to get athletes back to the top. If it wasn't for professional athletes, we wouldn't have ACL surgery at the level it is now. So, they've driven quality, they've asked the questions of surgeons and doctors to improve treatment, so the whole population really benefits from this rather elitist practice.

What have you learnt from the types of injuries these elite athletes are sustaining?

Andy: Elite athletes are a different group and they are very instructive for me. They get rarer things which means that when I see that in a member of the general population, I don't miss it.

Rare presentations

Andy: We've studied certain injuries to the medial collateral ligament, for example, which only seems to happen in footballers. And many a patient from the general population would come to me having had months or even years of pain where no-one's been able to work out what it is. But because I treat elite athletes, I see it much more commonly than other surgeons - and in fact I've been able to put together a series on it and publish it. It's a very unusual thing so that's a great lesson learned from athletes.

Ordinary problems exaggerated

Andy: But the other thing is that athletes get ordinary problems but they're exaggerated tremendously and I'll give you an example. We see people with meniscal tears fairly frequently and if you treat the general population it would be very easy not to realise that there's a difference between a medial meniscal tear on the inner side of the knee, versus a lateral meniscal tear on the outside of the knee. They are chalk and cheese.

What can the impact of operating on the meniscus be?

Andy: If you deal with athletes, removing meniscus on the inner side of the knee has fairly little consequence in the short to mid term - when they're middle aged or in old age they might get some arthritis. But to remove any meniscus on the outside of the knee, the lateral meniscus, it's really the beginning of the end of that athletes knee.

And the most common reason I will retire a player from football or rugby for example, is following the consequences, in terms of arthritis, of having some of that meniscus removed.

So, I've learned that at all costs, we must try and preserve the lateral meniscus by repairing it, rather than removing it if it's possible.

Mr Andy Williams is co-founder of Fortius Clinic in London. He, and Mr Jonathan Lavelle, Consultant Knee Surgeon, set up Fortius Clinic to improve orthopaedic and sports medicine - operating within a multidisciplinary team of over 100 other specialist surgeons and clinicians.