Mass Media interview

Doctor Milenin: Torn cruciate ligament isn’t the sentence for an athlete.

The number of sports injuries exceeded all possible limits during recent years: almost every day  the news about one more athlete who got a serious trauma appear in the press. Shoulder and knee meniscal injuries aren’t the worst  things, but the diagnosis of torn Cruciate ligament can sometimes make an athlete  leave his favourite business, and it doesn’t matter whether you are an amateur or a professional athlete. One of the leading sports  traumatologists  of the country, Doctor Oleg Milenin  in the exclusive interview for “Championat.ru” compared the level of Sports Medicine in Russia and abroad, told about the details  of rehabilitation process after surgeries and shared his experience in joint treatment.

-Oleg Nikolaevich, people in our country believe that  “good” performance of knee or, for example, shoulder surgery is possible only abroad:  Russian football players, and other athletes  are mostly  operated on in West Europe countries. Is such point of view fair and what can our medicine offer?

-Of course, some time ago Russia indeed remained behind recognized Orthopaedic  leaders.  All modern methods of surgery on large joints came to us from the West, but  they have already been successfully used in our country for many years. Now leading clinics perform only so-called arthroscopy, or minimally invasive surgery. Knee or shoulder surgery used to be invasive (open), the joints were operated on through a large incision. But then in Japan, Europe and Unites States colleagues turned to arthroscopy. 
The essence of the method is that all necessary manipulations surgeon and his assistants do through small incisions  and watch the process on the display, using video optical system. All mentioned details allow to reach not only high accuracy but also reduce recovery terms , as the joint  is far less wounded. Nowadays such surgeries are a standard in the treatment all over the world, and they are performed not only in Moscow clinics, but also in many other Russian cities. 

-Why then for the treatment of our athletes the candidacy of Russian doctors isn’t often even considered? What advantages does Germany have, but  its reputation?

 -There is a good saying on this point : “A prophet is not recognized in his own land”. Me and my colleagues often ask ourselves this question and are not able to find the answer. There is absolutely no difference between medical equipment that we have in our  clinic and the one that German surgeons use. The materials used for ligament reconstruction all over the world are also the same. And they are generally made not in Germany, but in the USA and Japan. There is a very interesting fact. Me and my colleagues often take part in different international congresses, go around Europe. Guess who we meet constantly in orthopaedic clinics of Italia, France?

-Who?

-German athletes(smiling).

-How is that? They have Einhorn,Pfeiffer…

-We also asked about this . It turned out that German people don’t always trust their surgeons. It seems to them that they can be operated on better in another country. But it doesn’t mean that it is right. Einhorn, whom I met more than once at international congresses is a specialist of the highest level. Pfeiffer is an experienced doctor too, but the situation here is different: he is more famous in our country than in Europe. But he managed to build a good reputation, took a certain position and he can be congratulated with that. I’d say that Germany certainly has good, pedantic doctors, as well as any other European country.

-And what about our country?

-There are great specialists in Russia, too and people began to understand  it at last. Medical aid appealability to the leading Russian clinics raced up in the past few years. This fact is very important: it means that people trust us. And this isn’t a coincidence. Even inveterate skeptic would agree that the level of a surgeon depends a lot on his experience. In fact, about 70% of all surgeries on joints in Europe are performed by young surgeons with surgical practice about  5 operations per year! And it is considered  normal, nobody has any questions to them. To compare, our medical team performed 500 surgeries in the year 2006, 700 in 2007, more than 900 in 2008 and this year, by the most conservative estimates , there will be about 1100-1300. My specialization is knees and shoulders, and during the first three months of this year I have already performed more than 200 surgeries. And besides, there are foreigners among our patients, including the ones from the USA- surgery is more expensive there than in our country, but the quality of the treatment is comparable at all points.

-Which athletes are prone to knee traumas most of all?

-According to  ISAKOS (International Society of Arthroscopy, Knee surgery and Orthopaedic Sports Medicine), the most dangerous sport for knees is football. Professionals in this kind of sport have a training load on the knee joint that is equal to 10 points from 10. But the most interesting thing is that amateurs have 9 points on this scale, which means that it is as high as professional mountain skiers, basketball players and volleyball players have! The explanation for this is very easy: besides physical activity and interaction with a ball, football is a very contact sport. That’s why the threat for the joints is combined. The congresses on sports trauma prevention are held all over the world not for the first year. Really effective complexes of exercises for injury prevention  begin to appear now. But none of this methods, unfortunately, won’t ever be able to give a one hundred per cent guarantee for the lack of traumas.

-The problems with knees are very common nowadays. But why have so many shoulder traumas occurred recently?

-Indeed, the number of such injuries have increased greatly now. The main reason is that all kinds of extreme sports are gaining fantastic popularity around the world. The fall there usually happens on upper limbs  , that are often not able to sustain such loads. You see only spectacular side of extreme on TV, and many people want to repeat all these tricks at once. But not everyone understands that these kinds of sports are not only drive and adrenaline, but also a colossal danger.

Many people think that the most difficult thing in the treatment of serious joint traumas is a surgery. But it lasts only a few hours, and the recovery sometimes takes many months. To sum up, how high are patient’s chances  to come back to sports?

 -There are two important details. First of all, how soon the surgery was performed. Let’s consider a classic case- torn cruciate ligament. If the surgery is performed in the period up to six months after getting trauma, the chances of returning to the same level of physical activity (and reaching new, even higher one) are very high. According to the statistics of our clinic, they are close to one hundred per cent. But even for the patients, operated on during the period from six months to two years, the chances are equal to 97 %, from two to ten years- 92 %. Regarding inveterate injuries, the prognosis ,unfortunately, is  less optimistic. The injured joint wears away much and the patient may even be recommended joint prosthesis, i.e. its replacement  in distant future. In this case, of course, we’re not talking about any active kinds of sport activities. That’s why it is so important to visit a qualified doctor in time. The cruciate ligament trauma isn’t a sentence  for a professional, as well as for an amateur.

 Then it is necessary to take into consideration that a well-performed surgery is only a half of success. Another half consists in the wise recovery. I admit that we still have some problems with rehabilitation in our country. Many doctors recommend all the patients with anterior cruciate ligament plasty a standard recovery complex. But it is wrong! The rehabilitation should directly depend on the method of surgery performed. If ACL is reconstructed with patellar tendon, patient should do one complex of exercises, if with semitendinosus muscle- another one. Some colleagues don’t think about it, or just don’t know. But the secret of fast recovery often lies exactly in the type of rehabilitation.

Your experience was very useful to the Russian athletes at the Olympic games in Beijing, where you were one of the doctors of our national team . Is there a big difference between a patient-professional and a patient-amateur?
- Anyway, orthopaedists treated all our athletes and I’d say that the main distinguishing feature a professional has is the character. I was surprised by the way they were focused on the victory- no matter if we speak about a weightlifter or a synchronized swimmer. By the way, with a representative of this kind of sport, Anastasia Ermakova we had a difficult situation in Beijing. Her old injury got worse, but conservative methods of treatment undertaken by our medical team seemed to do her good: she won two gold medals. If we speak about the surgery, I was astonished by another Russian athlete- canoeist Yulia Salakhova. Not long before the Olympic games she came to me with a shoulder trauma. And in two weeks after surgery she went to the Olympics, where she reached the final. Another incident, although it was not Olympic, can be considered unique. Our mountain skier, a specialist in freeride Liza Tambovtseva, had her meniscus injured after the stage of the World cup in Krasnaya Polyana and came to me for a surgery. As soon as she woke up from anesthesia, she told me that she was going to take part in the next stage in Dombay in ten days. I strongly recommended her not to do it, but Liza didn’t listen to me and… brought “silver” from Dombay! Though she had been only the 4th in Krasnaya Polyana. She called me up laughing: “Oleg Nikolaevich, my competitors are going to visit you, they want you to twist something in their knees, too “(smiling).

-And what about ordinary patients? Have they ever surprised you?
-Many times I caught myself on thought that I should expect everything from them. There was a funny incident when one woman tried to test me and brought to the appointment…an X-Ray of her dog. “Have a look,-she said,-what’s going on with my knee”.-“I have no idea about you, but your dog has no problems with it”-I replied. She started to resent, but then confessed, of course. She smiled and said:”You won’t believe, doctor. Five physicians already prescribed me the treatment , using this X-Ray”(laughing).