Division of Sports and Arthroscopic Surgery is a unique division in the Department of Orthopaedics and Traumatology, The University of Hong Kong. Unlike majority of orthopaedic surgeons who provide treatment in bone and related disorder in an open manner, sport medicine surgeons in our division are specialists in diagnosing and treating pathologies of soft tissue (e.g. tendon, ligament, capsule, cartilage, meniscus, labrum, etc) in musculoskeletal system (e.g. hip, knee, shoulder, etc) through a minimal invasive approach with the help of an optical instrument (i.e. arthroscope).
Arthroscopy was practiced in this department since early 1960s. It became a much more popular technique in Hong Kong after the first “Arthroscopic Instructional Course and Workshop” held by the International Arthroscopic Association in our department in 1985.
The use of arthroscopy allows majority of joints in human body, including shoulder, hip, knee, etc, to become accessible in a minimal invasive manner. Hence, it is not surprising to find that arthroscopy becomes an increasingly popular method in assessment and treatment of orthopaedic problems in Hong Kong.
The rapid development in technology and instrumentation in arthroscopy in the past thirty years leads to a widespread application of this technique. Nowadays, the use of “arthroscope” is no longer limited to naturally occurring body space (i.e. joint) but is extended to areas with pathologies which previously can only be assessed and managed by open surgery (e.g. endoscopic assisted quadriceps tendon repair, arthroscopic Latarjet operation, etc). The adoption of “arthroscopic-assisted” and “endoscopic-assisted” concept in the field of orthopaedics makes the practice of minimal invasive surgery possible. The recovery of the patient is fastened and potential complications are minimized.
The work of Division of Sports and Arthroscopic Surgery in the Department of Orthopaedics and Traumatology can be described using the “Three-pillars” concept, namely clinical service, teaching and research.
Clinical service is the most important component in the “Three-pillars”. It is because the primary duty of a doctor is to provide diagnosis and treatment to the sick and disabled. Active engagement in clinical service allows a physician to reflect on the limitation of themselves and current technology. This provides the momentum to improve, both by teaching and active participation in research.
At the current moment, Division of Sports and Arthroscopic Surgery provides service in the field of sports medicine related problem in shoulder (including acromioclavicular joint), knee (including patello-femoral joint) and hip. The more common pathologies that we treat include: shoulder dislocation and instability, rotator cuff tear, frozen shoulder, acromioclavicular joint dislocation and arthritis, cuff tear arthropathy of shoulder, isolated cartilage injury of knee, meniscal tear, quadriceps tendon rupture, patellar tendon rupture, anterior cruciate ligament tear, posterior cruciate ligament tear, patellar dislocation and instability, hip labral tear, snapping hip, etc.
We conduct six outpatient clinics for general public every week, including one general outpatient clinic, two sports outpatient clinic (one on shoulder, one on hip and knee), one pre-operation assessment clinic, one post-operation clinic and one new case clinic. We provide care to a total of more than 2,000 outpatients each year.
The Division runs four operation sessions each week. We operate a total of 150 to 200 surgeries each year. These include arthroscopic assisted shoulder surgery (including Bankart repair, SLAP repair, Latarjet procedure, rotator cuff operations, biceps tendon surgery, repair and reconstruction of acromioclavicular joint dislocation, etc), open shoulder surgery (e.g. reverse total shoulder arthroplasty), arthroscopic assisted knee surgery (including meniscal operation, cartilage operation, anterior cruciate ligament reconstruction, etc), endoscopic assisted knee surgery (including repair of extensor mechanism rupture, repair of medial patello-femoral ligament tear, etc) and open knee surgery (including high tibial osteotomy, Fulkerson osteotomy, trochleoplasty, etc). Majority of surgery (over 95%) is done in a minimal invasive manner with the help of an arthroscope. The length of in-patient hospitalization is typically short. Day surgery is practiced in selected case.
We believe that it is important to teach our next generations the correct approach and essential knowledge in managing patients with sports medicine problem. Over the years the division has been heavily involved in teaching of medical students, post-graduate students, orthopaedic trainee, local and overseas orthopaedic fellows.
The division is responsible to provide regular teaching to local medical students and overseas exchange students in the area of shoulder and knee problem throughout the curriculum. The total teaching contact hours are more than 1,000 student-hours per year.
The division is also involved in teaching trainee working in Hospital Authority (including those in basic surgical training program and higher orthopaedic training program). With collaboration of Hong Kong College of Orthopaedic Surgeons, teaching conferences, sports medicine related clinical tutorials and theme-based educational day are conducted regularly by our division. A total of more than 250 trainees were taught by us in the past ten years.
The division provides skill-based teaching to orthopaedic surgeons (both local and overseas) by organizing and teaching cadaveric workshop concerning arthroscopic surgery of knee and shoulder. We are involved in running more than 10 cadaveric workshop in the last decade. Over 150 orthopaedic surgeons were trained.
Despite the fact that anterior cruciate ligament reconstruction is a commonly performed operation, significant issues in terms of suboptimal graft incorporation within the bone tunnel, lack of suitable tools for outcome assessment and potential inaccuracy in tunnel position are still areas that receive a lot of attention. Many surgeons believe that there is still much room for improvement in this most commonly performed operation in the field of Sports Medicine. In order to address this, Division of Sports and Arthroscopic Surgery is now investigating possible methods in improving the result of ACL reconstruction, through both basic science approach (e.g. enhancing graft incorporation in ACL reconstruction using strontium and stem cell technology, improving precision of tunnel position placement through computer navigation surgery) and clinical approach (by developing new surgical method in ACL reconstruction). The classic “pivot shift” test is now revisited using motion analysis technique. We believe that this will lead to a better understanding in ACL reconstruction surgery and hopefully result in improvement in the standard of care in this commonly performed operation.
Management of chondral lesion is currently a popular topic of discussion in the world of orthopaedics. Autologous chondrocyte implantation is considered to be the standard of care. Despite of the high cost, the regenerated tissue is still far from optimal. We are now working with the Department of Medical Engineering of the University of Hong Kong to explore the possibility of combining a novel scaffold and stem cell technology in treating this problem. We hope that this will result in an ultimate solution for this difficult clinical problem.
Rotator cuff tear can be found in over half of the population at or older than sixty-years old. The result of surgical repair is suboptimal with a reported failed healing rate ranging from 20 – 70%. The relatively slow healing of diseased tendon in the tendon-bone interface and the suboptimal mechanical property of degenerated tendon are considered to be two main reasons of this high failure rate. We are investigating along the line of improving the result of rotator cuff repair by stimulating tendon-bone healing by biological augmentation, strengthening tendon-suture interface by developing new methods of repair and new methods of tying arthroscopic knots. The researches are conducted in both the area of basic science and clinical study.
- Role of Strontium in interfacial tissue engineering in tendon healing and ligament reconstruction
- Biomechanical study of a new arthroscopic knot – “HK-knot”
- Feature based 2D-3D registration and 3D reconstruction via statistical inference for image-guided interventions
- Development of new surgical technique for knee and shoulder surgery
- Combined Anterior cruciate ligament reconstruction and anterior-lateral ligament reconstruction
- Osteometry of Chinese and its impact in orthopaedic disease and intervention
- Computer navigation orthopaedic surgery
Management of traumatic patellar dislocation in a regional hospital in Hong Kong.
HL Lee and WP Yau.
Hong Kong Medical Journal, 2017, 23(2): 122-8.
Prevalence of Radiographic Parameters Predisposing to Femoracetabular Impingement in Young Asymptomatic Chinese and White Subjects.
JV Houcke, WP Yau, CH Yan, W Huysse, WH Lau, CS Wong, C Pattyn and EA Audenaert.
Journal of Bone and Joint Surgery Am, 2015, 97A:310-7.
Strontium exerts dual effects on calcium phosphate cement: accelerating the degradation and enhancing the osteoconductivity both in vitro and in vivo.
GM Kuang, WP Yau, J Wu, et al.
Journal of Biomedical Materials Research: Part A, 2015, 103(5): 1613-21
Anterior cruciate ligament tear in Hong Kong Chinese patients.
AWM Fok and WP Yau.
Hong Kong Medical Journal, 2015, 21(2):131-5.
Local application of Strontium in a Calcium Phosphate Cement System Accelerates Healing in Soft Tissue Tendon Graft in Anterior Cruciate Ligament Reconstruction – a Rabbit Experiment.
GM Kuang and WP Yau.
American Journal of Sports Medicine, 2014, 42(12): 2996-3001
Femoral Radiographic Landmarks for Popliteus Tendon Reconstruction and Repair – A New Method of Reference.
AWM Fok, GM Kuang and WP Yau.
American Journal of Sports Medicine, 2014, 42(2):394-398.
Isolated bundle tears of anterior cruciate ligament: correlation with elapsed time from injury to surgery and physical examinations.
AWM Fok and WP Yau.
Journal of Orthopaedic Surgery, 2014, 22(2):209-13.
Use of a Strontium-enriched Calcium Phosphate Cement in Accelerating the Healing of Soft Tissue Tendon Graft Within the Bone Tunnel in a Rabbit Anterior Cruciate Ligament Reconstruction Model.
GM Kuang, WP Yau, WW Lu and KY Chiu.
Bone and Joint Journal, 2013, 95B(7):923-8.
Tunnel Positions in Transportal Versus Transtibial Anterior Cruciate Ligament Reconstruction: A Case-Control Magnetic Resonance Imaging Study.
WP Yau, AWM Fok and DKH Yee.
Arthroscopy, 2013, 29(6):1047-1052.
Distal femur rotation relates to joint obliquity in ACL deficient Chinese.
WP Yau, KY Chiu, AWM Fok, CH Yan and FY Ng.
Clinical Orthopaedics and Related Research, 2013, 471:1458-1464.
Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries.
August WM Fok and WP Yau.
Knee Surgery Sports Traumatology Arthroscopy, 2013; 21:928-933.
Early Results of all-inside meniscal repairs using a pre-loaded suture anchor. AWM Fok and WP Yau.
Hong Kong Medical Journal, 2013, 19(2):124-8.
An effective approach by a chelate reaction in optimizing the setting process of strontium-incorporated calcium phosphate bone cement.
GM Kuang, WP Yau, WM Lam, Jun Wu, KY Chiu, WW Lu and H Pan.
Journal of Biomedical Materials
Osteointegration of soft tissue grafts within the bone tunnels in Anterior Cruciate Ligament reconstruction can be enhanced.
GM Kuang, WP Yau and W Lu. Knee Surgery, Sports Traumatology, Arthroscopy, 2010, 18:1038-1051.
Osteoconductive bone cement enhances tendon-bone healing in anterior cruciate ligament reconstruction.
GM Kuang, WP Yau, FL Lim, KY Chiu and WW Lu. Orthopaedic Journal of China, 18 (16):1349-1353, August 2010.
A simple device in shoulder arthroscopy: the suture assistant.
Yip DK, Wong JW
Arthroscopy. 2005 Sep;21(9):1151
The peashooter device: an invaluable tool for bone grafting during revision anterior cruciate ligament surgery
Wong JW, Yip DK.
Arthroscopy. 2005 Aug;21(8):1010.
How to use cuff suture instruments: the concept of “concave in and concave out”
Yip DK, Wong JW, Kong JK
Arthroscopy. 2004 Jul;20 Suppl 2:100-2
Half-stained thread in shoulder arthroscopy: an improved method of suture management
Kong KF, Wong JW, Chien P, Yip DK.
Arthroscopy. 2004 Apr;20(4):442-3.
Peroneal padding: an alternative to a peroneal post in hip arthroscopy
Kong KF, Chien P, Wong JW, Yip DK
Arthroscopy. 2003 Nov;19(9):1027-9
A broken sewing needle in the knee of a 4-year-old child: is it really inside the knee?
Yeung Y, Wong JK, Yip DK, Kong JK
Arthroscopy. 2003 Oct;19(8):E18-20
The mini vent technique: a simple method to facilitate accurate secondary portal placement in shoulder arthroscopy
Yip DK, Kong JK, Wong JW
Arthroscopy. 2003 Oct;19(8):E12-3
Arthroscopic surgery in the posterior compartment of the knee: Suture fixation of anterior and posterior cruciate ligament avulsion
Yip DK, Wong JW, Chien EP
Arthroscopy. 2003 Mar;19(3):23E
How to overcome severed sutures of the tibial bone peg in anterior cruciate ligament reconstruction
Yip DK, Wong JW, Chien EP
Arthroscopy. 2002 Mar;18(3):E12
Arthroscopic treatment of patellar symptoms in posterior stabilized total knee replacement.
JWK Wong, PWP Yau, PKY Chiu
International Orthopaedics, 2002; 26:250-252
Is MRI necessary for diagnosing acute ACL injury?
Hong Kong Journal of Sports Medicine, 1999; 8:1-5