Surgery

Welcome to the site of Dr Nikos G. Malliaropoulos. In this site you can find information about our Sports Medicine clinic, the treatments of Sports Injuries that we perform as well as details about our publications and articles in Sports Medicine journals and conferences.The surgery

Radial Shock Wave Department

Our clinic is also equipped with a Radial Shock wave therapy department. Radial shock wave therapy is an updated therapy method for Sports Injuries especially for tendinopathies, muscle injuries and ligament injuries.

Shockwave therapy for MSK Pathologies (ESWT)

Patient Information
Radial Shockwave Therapy is a series of energetic shockwaves applied to the area that needs treatment. A shockwave is a purely mechanical wave, not an electric one. The treatment initiates an inflammation-like condition (pro-flamatory) in the tissue that is being treated.

The body responds by increasing the blood circulation and metabolism in the impact area which in turn accelerates the body's own healing processes. The shockwaves break down injured tissue and calcifications.

'ESWT offers two main advantages over traditional surgical methods: fewer potential complications and a faster return to normal activity' FDA

-No anaesthesia
-Non invasive
-No medication
-No surgery
-Fast treatment-30 minutes per session, 4-8 sessions required
-Fewer complications
-Virtually painless after treatment
-Significant clinical benefit often seen 6-8 weeks after treatment

How does ESWT work?
-The shockwave is delivered to the tissue via a compressed air impulse exerted by the hand piece.
-The shockwave radiates out, extending to the entire area where pain occurs.
-Usually no more than 4-8 sessions are needed depending on the pathology .
-Each treatment takes approximately 10 minutes to be delivered
-No anaesthetic is required and you can continue usual activities.(It is recommened to avoid pain provoking exercise for 48 hours following treatment.)
-No surgery or other therapy is required and treatment can usually start straight away.

FOCUS SHOCKWAVE THERAPY RADIAL SHOCKWAVE THERAPY RADIAL SHOCKWAVE THERAPY FOR ELBOW Results of the treatment E.S.W.T. MASTERPLUS MP200 DUOLITH SD1

Laser Department

LASERNEEDLE

LASERNEEDLE THERAPY

The LASERNEEDLE therapy is an innovative medical concept for the painless and noninvasive treatment in sports medicine and rehabilitation. The irridiation of the therapeutic laser with high power density technology (HPD) opens up new therapeutic possibilities.

GENERAL INDICATIONS:

SPECIFIC INDICATIONS

BENEFITS FOR THE PATIENT

FUNCTION

The LASERNEEDLE light therapy concept: therapeutic effects through precise, high power density (HPD) laser treatment. The HPD principle allows reaching the desired therapeutic results even with the use of low-level lasers. It prevents the redundant laser irridation of nearby regions and eliminates the risk associated with using more powerful lasers.

THE LASERNEEDLE HPD TECHNOLOGY

great results- no side effects

The specific LASERNEEDLE technology allows the direct modulation of biochemical reactions in the cell. Stronger, class 4 lasers pose the risk of burn injuries due to their thermal effect (overheating).

The laser needles can be attached directly to the patients body for the entire treatment duration, without risk of burning or injury. The presence of the therapist during the treatment is therefore not necessary.

The LASERNEEDLE technology is significantly efficient without any of the risks fo a class 4 laser.

THE EFFECTS OF RED- AND INFRARED LASER LIGHT

 

Platelet Rich Plasma (PRP)

An innovative treatment, for  Musculoskeletal Pathologies , PRP uses your own blood for healing muscle, tendon and ligament injuries. 

A common form of healing is scarring which affects function . Most of the Current therapies  treating sports Injuries  do not change the intrinsically poor healing properties. Given this situation, biologically based strategies involving the stimulation of cell activities through the delivery of Growth Factors have attracted considerable interest. 

Platelet Rich Plasma is derived by placing a small amount of your blood in a filtration system which separates red blood cells from platelets. The high concentration of platelets (containing a high level of Growth Factor) is then injected into the injured tissue which initiates the body’s natural healing response.

All the injections provided at European Sports Care Set up are  under Ultrasound Guided

After treatment cold therapy/icing of the affected area may be used.

Usually 2-3 injection are needed depending on the severity of the injury and the chronicity of the symptioms .


References
1. Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.
2. Woolf AD, Pfleyer B. Burdon of major musculoskeletal conditions. Bull World Health Organ. 2003;81:646–56.
3. Cassel EP, Finch CF, Stathakis VZ. Epidemiology of medically treated sport and active recreation injuries in the Latrobe Valley, Victoria, Australia. Br J Sports Med 20032; 37: 405-9.
4. Anitua M, Sánchez E, Nurden A, Nurden P, Orive G, And ́ıa I. New insights into and novel applications for platelet-rich fibrin therapies. Trends Biotechnol. 2006;24(5):227–34.
5. Praemer AF. Musculoskeletal conditions in the United States. 2nd ed. Rosemont: American Academy of Orthopaedic Surgeons; 1999.
6. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74


Musculoskeletal Medicine

Platelet rich plasma injections (PRP injections) can be used in the treatment of many musculoskeletal injuries including that of tendons, muscles and joints. Typically 2 or more injections are required, separated by 1-4  weeks apart. This may vary depending on your injury.

Muscle and Tendon injuries can be treated with PRP

Muscles Injuries

Tendon Injuries:

What other injuries can be treated with PRP?

How is PRP different?


PRP can potentially accelerate  healing and reduce injury time.

PRP with its concentration of growth factors stimulates the healing process (8).

 PRP focuses on restoring normal tissue composition while avoiding further degeneration.


References

  1. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.
  2. Antitua E, Andia I, Sanchez M, Azofra J, Del Mar Zalduendo M, De La Fuente M, et al. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF productions by human tendon cells in culture. J Orthop Res. 2005;23:281–6.
  3. Fenwick SA, Hazlelman BL, Riley GP. The vasulature and its role in the damaged and healing tendon. Arthritis Res. 2002;4: 252–60.
  4. Hayem G. Tenology: a new frontier. Joint, Bone, Spine. Rev Rhum. 2001;68:19–25.
  5. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;10(10):1–5.
  6. Jobe F, Ciccotti M. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1–8.
  7. Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. Am J Hand Surg. 2003;28(2): 272–8.
  8. Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med. 2009;39(5):345-54.
  9. Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2011 Dec 28.
  10. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, Fornasari PM, Giannini S, Marcacci M. Arthroscopy. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. 2011 Nov;27(11):1490-501.
  11. Sánchez M, Guadilla J, Fiz N, Andia I. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology (Oxford). 2012 Jan;51(1):144-50.
  12. Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):528-35.
  13. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cuscó X, Garcia-Balletbó M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Arch Orthop Trauma Surg. 2011 Mar;131(3):311-7.
  14. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9.


Platelet Rich Plasma (PRP) Injections : The Procedure

Ultrasound Guided is used to image the site of injury .There is no exposure to ionising radiation. It is the same technology used in pregnancy imaging.


Platelet Rich Plasma (PRP) Injections : Safety


This section address potential adverse effects and contraindications to platelet rich plasma (PRP) injections. The 2011 World Anti-Doping Code (WADA) has deemed all musculoskeletal PRP injections to be considered legal with no notification required. However, if you are an athlete and in a registered testing pool, always confirm with your practitioner the latest WADA regulations as they may have changed.


Side Effects

Platelet rich plasma (PRP) is prepared from autologous or the patient’s own blood so there is no risk of developing a growth of tumour or cancer (1). Adverse effects are rare but as with any injection there is always the small risk of infection or injury to nerves or blood vessels. Scar tissue formation and calcification at the injection site are also possible (2).

Is it painful?
It is usual that you may feel some pain during and following the injection. Our doctors prefer that you use paracetamol (e.g. Panadol) for pain relief.
If you experience persisting severe pain or an adverse reaction following the injection, please contact us.

References
1. Everts P, Knape J, Weirich G, Schonberger J, Hoffman J, Overdevest E, et al. Platelet-rich plasma and platelet gel: a review. JECT. 2006;38:174–87.
2. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.



When you should not have PRP

You should not have a PRP injection if you have the following (2):

You should also not have a PRP injection if you are pregnant or are breastfeeding. (2)



Medications to avoid before PRP

You should not have a PRP injection if you have used non-steroidal anti-inflammatory medications (NSAID’s) in the 7-10 days leading up to your appointment. If you are considering having this injection, please switch to another painkiller such as paracetamol or for other options, check with your local doctor or chemist.


WADA and PRP (Anti-Doping Requirements for Athletes)

The World Anti-Doping Authority (WADA) has deemed all musculoskeletal PRP injections for athletes legal to use with no notification required.(3)

Click here to view the official WADA 2011 statement on Platelet-Derived Preparations.

"Platelet-Derived Preparations
Platelet-derived preparations (commonly referred as PRP or blood spinning), prohibited in 2010 when administered by intra-muscular route, have been removed from the List for 2011 after consideration of the lack of current evidence concerning the use of these methods for purposes of performance enhancement. Current studies on platelet-derived preparations do not demonstrate a potential for performance enhancement beyond a potential therapeutic effect."

Before having an injection, always ask your doctor for the latest information on the WADA.

References
1. Everts P, Knape J, Weirich G, Schonberger J, Hoffman J, Overdevest E, et al. Platelet-rich plasma and platelet gel: a review. JECT. 2006;38:174–87.
2. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008 Dec;1(3-4):165-74.
3. World Anti-Doping Agency [online]. Available from URL: http://www.wada-ama.org/en/Resources/Q-and-A/2011-Prohibited-List/ [Accessed July 21, 2011]

 

Recent Announcements

Tuesday, 27 Sep 2016

5th Congress of ECOSEP & 2nd UAE FA Football Medicine Update 25th-27th November 2017 Dubai

read more

Monday, 05 Sep 2016

5th ANNUAL PODIATRIC SPORTS MEDICINE CONFERENCE In association with EUROPEAN COLLEGE OF SPORTS & EXERCISE PHYSICIANS INSPIRING CLINICAL EXCELLENCE – THINKING BEYOND BIOMECHANICS

read more

Recent Articles

Platelet Rich Plasma (PRP)

An innovative treatment, for  Musculoskeletal Pathologies , PRP uses your own blood for healing muscle, tendon and ligament injuries. 

A common form of healing is scarring which affects function . Most of the Current therapies  treating sports Injuries  do not change the intrinsically poor healing properties. Given this situation, biologically based strategies involving the stimulation of cell activities through the delivery of Growth Factors have attracted considerable interest. 

Platelet Rich Plasma is derived by placing a small amount of your blood in a filtration system which separates red blood cells from platelets. The high concentration of platelets (containing a high level of Growth Factor) is then injected into the injured tissue which initiates the body’s natural healing response.

read more

Extra Shockwave Therapy & Treatment

At European SportsCare, Extracorporeal Shockwave Therapy (ECSWT) is available for the treatment of musculoskeletal softtissue pathology such as Tendon, Ligament, Muscle and bone. Shockwave Therapy is a non-invasive treatment provided by fully trained Consultants providing this treatment for more than 15 years. It is available as an out-patient treatment in one of our comfortable consultation rooms at 68 Harley Street.

read more

Acute Lateral Ankle Sprains In Track & Field Athletes: A Proposal Of An Expanded Classification

We present a longitudinal observational study on classification of acute lateral ankle ligament injuries in track & field athletes, based on objective criteria. These very common and sometimes troublesome sports injuries are treated functionally but there is a lack in international literature in predicting the time needed for full recovery.

read more

Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes

Objective: To compare long term outcome of highly active patients with anterior cruciate ligament ruptures treated operatively versus non-operatively.

Design: We reviewed high level athletes with an anterior cruciate ligament rupture on either MRI or arthroscopic evaluation more than 10 years previously, who were treated conservatively. They were pair-matched with patients who had had an anterior cruciate ligament reconstruction with bone-patella-tendon-bone, with respect to age, gender and Tegner activity score before injury.Participants: In total 50 patients were pair-matched.

Results: We found no statistical difference between the patients treated conservatively or operatively with respect to osteoarthritis or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Conclusion: We conclude that the instability repair using

a bone-patella-tendon-bone anterior cruciate ligament reconstruction is a good knee stabilising operation. Both treatment options however show similar patient outcome at 10 year follow up.

read more

ACL injuries. Diagnosis, treatment and rehabilitation

The ability to recognize the ACL deficient knee is lacking, even among orthopaedic surgeons. The history of an acute ACL tear is remarkably constant, because the injury is often non contact, and patients usually report a twist on the flexed knee, turning to the same side as the injured knee, although hyperextension or direct injury is the cause in some sports. Patients often remember a loud pop, but, because there are no nociceptors in the ACL, pain is not an immediate feature in the isolated lesion. Players may attempt to continue to play, but they usually stop because the knee feels insecure. Pain ensues in association with a hemarthrosis: 70% of acute hemarthroses of the knee are associated with a tear of the ACL. The diagnosis must be confirmed before treatment is offered.

read more