Real Madrid matching injuries to surgeons

By inviting Dutch orthopaedic specialist Cornelis Niek van Dijk to lead the surgical teams operating on Real Madrid players Danilo and Keylor Navas, the club have clearly opted to match their choice of surgeon to the injuries in question.

It's an interesting choice they've made and it's a refreshing change to see the top orthopaedic people actually coming to Madrid to perform these operations instead of a constant stream of footballers heading in the opposite direction.

We've said before in these articles that Real Madrid players should have no need to leave the country to take specialist medical opinion as there are enough experienced doctors and surgeons in Spain.  However, if the club want to take medical opinions from people outside of Madrid then at least they're coming into the club rather than the other way round.

It would be nice to think that the two operations performed last week would indicate the shape of things to come.  Real Madrid's medical services have come in for a fair bit of criticism over the past couple of years, and obviously we're not privy to what goes on behind closed doors, but if the policy is to try to have operations and even consultations with outside specialists held ‘at home' then that's a decision to be commended.

There's always an issue with players having surgery away from the parent club.  The club medical people don't like it because they want to keep an eye on everything right through from the moment the injuries are sustained until the players eventually return to action.

It's not so easy if a player rings in one morning and says his knee has swollen up and the surgeon who performed the operation is on the opposite side of the globe.  Instead of being able to take a quick opinion from the specialist in question, the whole process becomes dragged out over the best part of a week when you consider the timescales involved once the travelling and flights etc are all taken into consideration.

That's not including any further investigations that the consultant might want to make if the player's condition then warrants a revised opinion.

It's far quicker and easier to ask the specialists to come to the club; that way at least the wheels can be set in motion right away for the next stage -€” if there is to be a next stage that is -€” without any undue delay.

We note the same words are present in the club's statement about both Danilo and Keylor Navas that "the player will stay in Madrid to start work on his rehabilitation immediately".

The value of supervised treatment and rehab care in the early stages after surgery is no longer underestimated and gone are the days when a player would spend the first few weeks sitting at home "recuperating" when what's really required is to be keeping an eye on the after-effects of the procedure.

In ACL surgery, for example, the most important period is during the first three weeks postoperatively and correct management at that stage often sets the scene for the success or failure of the operation.

Of course, from a player's point of view, to be injured a long way from home isn't pleasant and that's sometimes why they like to fly back to their own country if their injury is likely to involve a lengthy period out of action.   However, from a club aspect, this can quickly turn into a bad habit and before you know it, you suddenly have two or three key players missing out on the most important time of their treatment and rehabilitation.

So with both Keylor and Danilo remaining in Madrid as opposed to heading off for a few weeks the Real medical people (and Professor van Dijk himself) will be able to foresee any potential issues thanks to having the players around.

Professor van Dijk will have been chosen largely due to his reputation as an ankle and foot specialist.  He's written numerous papers on injuries to the lower limb and his clinic in Amsterdam has reportedly been visited by several top athletes and sportsmen over the years.  His accessibility to Madrid geographically will also have been a plus.  It's well done to him as well for agreeing to perform the surgery in Madrid as I'm sure there will be many consultants who would be only too happy to see Real players in their own private clinics.

It was also interesting to note that the operating team in both cases included two of Professor van Dijk's associates, Hélder Pereira and Pedro Luis Ripoll, who alongside the Dutch surgeon recently published on the subject of ankle arthroscopies earlier this year (Pereira et al, 2016).  Hélder Pereira is a FIFA-accredited orthopaedic consultant and like Professor van Dijk is highly involved in sports medicine in Spain and Europe.

The fourth member of the team, Mariano De Prado is a colleague of Pedro Luis Ripoll; and together they have a FIFA-certified clinic in Elche and like Professor van Dijk are highly specialised in their field.

The concept of matching injuries to specialist people in the field ensures that whoever is providing the care sees in effect the same type of injuries day-in day-out instead of a specialist hand surgeon for example performing a knee operation.   By the same token, involvement with FIFA and the world game ensures that the specific understanding of football medicine is well catered for.

Although all surgeons are highly proficient in dealing with all areas of the body, specialisation in a particular field can often make all the difference.  It looks as though the club have really done their homework here in going for the top people and all credit must be rightly given where it's due.

Reference: Pereira H, Vuurberg G, Gomes N, Oliveira JM, Ripoll PL, Reis RL, Esprequeira-Mendes J, Niek van Dijk C (2016).  Arthroscopic Repair of Ankle Instability with All-Soft Knotless Anchors.  Arthroscopy Techniques. Vol. 5 (1); e99 -€” e107.  doi: 10.1016/j.eats.2015.10.010. eCollection 2016.