Saturday 28 November 2009

Injuries - oh f*ck and dodgy foreign surgeons

That's exactly what I thought when I heard the news about RVP needing surgery on his ankle injury which will keep him out for possibly the rest of the season. Watching the above video also makes me angry, to me Chiellini has gone in dangerously on RVP, this was a 'friendly match', he slides in with studs up and with a straight leg and nails RVP's standing leg, it was a bad tackle and it has cost us big time.

The same was true for Kieran Gibbs' fractured metatarsal, the game was over, we were cruising two nil and the Liege player slid in out of control with his studs up, clobbering Gibbs after the ball had gone. Both tackles were reckless, it matters not whether the ball was won or not, sliding in with your studs up should not be tolerated in the modern game, the problem is that refs are too stupid to pick up this kind of malignant play, they prefer to send people off for pushing someone in the chest or other kinds of harmless handbags. Until dangerous play is punished consistently in proportion with the threat it poses these kind of needless injuries will continue to happen far too frequently.

RVP has been advised to have surgery by a Dutch foot and ankle surgeon. Obviously it is hard to speculate as to whether RVP needs an operation, but it is rather obvious that there are a lot of rather cunning surgeons out there who are only too happy to milk the footballing gravy train for their own wallets. If RVP has a lateral ligament rupture which I suspect he does, then our Dutch man has produced evidence to say that reconstruction gives better long term results.

Nothing is sure in science and medicine, no matter what some people would have you believe, one can always find evidence to back up one's opinion, it is invariably the interpretation of the evidence that is key. If RVP has a lateral ligament rupture that to me is seems that having early surgery is not the sensible option. There is a lot of evidence to back this view up (1, 2).

"There are other reasons to consider functional treatment as a method of choice. First, as has been reported by many authors , secondary operative reconstruction or delayed repair of the ruptured ligaments of the ankle can be performed years after the injury if necessary, with good results that are fully comparable with those of primary repair. Therefore, even competitive athletes may be treated functionally at first, with the realization that 10 to 20 per cent may need elective secondary repair. Second, functional treatment saves the patient from additional trauma to the tissues and complications that are caused by operation."

The above quote comes from one of the most authoritative texts in the scientific literature on managing lateral ligament ruptures. If one assumes that RVP has a lateral ligament rupture then not only if he was managed without surgery would he only have around a 10% chance of needing surgical repair later, he would avoid all the potential complications of surgery and be back playing quicker than following surgery. With surgery he is practically certain to miss the rest of the season.

Obviously this is all speculation, but it would not be the first time that an 'eminent' surgeon has advised early surgery against the best interests of the patient. Privatised surgery means that surgeons will be much keener to operate on patients when the benefits of surgery are minimal at best, this is the way of the world.

There is a well known German surgeon who performs 'hernia repairs' on lots of footballers with a remarkable technique that has them back playing within two weeks. Some surgical experts would say that this surgeons' technique is nothing but complete bullsh*t quackery and that the surgery involves around just making a cut, then doing bugger all to repair the hernia because most footballers have groin strains, not hernias in the first place. Michael Owen had his hernia 'repaired' in Germany by this quack, I suspect Nicky Bendtner may have also gone for the same expensive placebo treatment. Interestingly this strange hernia repair technique has absolutely no evidence behind it, there is nothing written on it in the scientific literature, I am just surprised that more people have not smelt the rat.

I am indeed a cynical bastard but we do live in a rather cynical world, the moral of the story is that it is always worth considering what people have to gain from the particular advice that they give.


tom said...

interesting post. great research. just have to hope your wrong, and it is necessary and will help. so disappointed about robin, not sure about our chances for anything unless we buy. I just dont have faith in Edu, Vela, Theo, Bendtner etc... as our main strike force. But i certainly dont think Chamack is the asnwer.

Anonymous said...

lets just beat Chelsea and roll from there.

great article. interesting viewpoint.