Interview with Dr Ramón Cugat Bertomeu
Dr Ramón Cugat Bertomeu is Head of the Department of Orthopaedic Surgery and Traumatology in the Hospital Quiron Barcelona and President of the Medical Association of the Catalan Mutual Insurance of Football of The Royal Spanish Football Association. In addition, he is part of the international team of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS). Dr Cugat studied medicine at the University of Barcelona and is regarded as a pioneer in arthroscopic surgery in Spain. At the 1992 Olympic Games in Barcelona, he was a member of the orthopaedic surgery team. He has worked in hospitals in Spain, England and the United States of America.
Dr Cugat, how many posterior cruciate ligaments (PCL) do you treat each year?
I carry out around 30 to 40 PCL treatments a year for members of the Royal Spanish Football Association.
What is the ratio between conservative and operative care?
Over half of PCL injuries are treated conservatively, because football players wish to avoid an operation as far as possible.
How do you treat PCL injuries?
If it is a partial rupture and the posterior drawer is seven to eight millimetres, I treat it conservatively. An operation is only carried out if there is a complete rupture and in combination with injuries to the posterolateral joint structures. In this case, the players need to be careful, since they generally have a varus deformity. This leads to a further load on the posterolateral joint structures. In addition, there is an overloading of the medial meniscus, the medial side of the patella and the femorotibial joint.
Do you make a distinction between the treatment of professional athletes and that of "normally athletic" people or patients?
Yes, slightly, because with people who are not professional athletes, the knee can also be immobilised for two or three weeks. The situation is different for professional sports people: They want to be able to play again instantly. For them, it is important to be able to be up and about and fit again quickly. So they tend to start with rehab measures. Also, these are more intensive for them.
As part of the care plan, you also use medi M.4s PCL dynamic knee brace. What properties are you most impressed with?
For me, one element that is particularly important for football players with a partial rupture is: In acute cases, we can move the tibia forward with the PCL knee brace, achieve a good alignment and maintain the position. In this way, we correct the posterior sag and good healing is possible. In addition, growth factors can be injected into the tissue of the posterior cruciate ligament.
How good is patient compliance if a knee brace such as the M.4s PCL dynamic is used?
Compliance is very high. Professional football players want to play again as quickly as possible and not wear a plaster cast or a splint. They are very happy with the medi knee brace, because they may be able to walk again even on the first or second day. They get used to the brace very quickly and get on with it famously.
Dr Cugat, thank you very much for talking to us.