Dressed in his blue scrubs and wearing plastic gloves, Ray Moran drills a hole in the bone that is attached to the tendon he’s just removed from Podge Collins’ knee. The Clare star’s leg lies limp in the operating theatre as the surgeon prepares to use that tendon to mend his torn cruciate.
It’s a surreal experience to stand just a couple of feet away as he works his magic on the 23-year old, almost like being an extra in a movie. Collins’ face isn’t visible as he lies on the operating trolley. All that can be seen underneath the blue sheet that covers him is his damaged left leg and all that can be heard is the beeping of the machines and the sounds of the surgeon’s instruments.
Before the surgery, Collins had quite a bit of hanging around to do. He had been fasting since the night before. On the television, in his room, Novak Djokovic — one of his idols — was playing Kevin Anderson and it was a welcome distraction.
As well as being hungry, he is feeling down about the Clare footballers losing to Longford and exiting the Championship. Even though he wasn’t playing, the defeat stung. Being injured while watching his team exit the action so early isn’t exactly how he expected his summer to pan out. He can’t shake the disappointment.
Earlier that morning, on the drive from Clare to the UPMC Sports Surgery Clinic in Santry, he searched Google for ACL surgery while his team-mate Gary Brennan drove. The results were graphic, but he was more concerned about the rehab and how soon could he return in earnest.
The anterior cruciate ligament connects the thigh bone to the shin bone. Its function is to control stability when performing twisting actions. It’s not needed much for daily living, but it is vital for sport.
“The cause of the injury is excessive stress to the knee,” explains Enda King, head of performance rehabilitation at the UPMC Sports Surgery Clinic
“There are two main groups: 75-80 per cent are non-contact and 25 per cent are from contact, so if someone hits your knee there is nothing you can do about that. The other 75 per cent have some sort of control deficit around the hip-trunk, knee or ankle that puts their knee in a dangerous position. That’s generally in a straightened position with their knee collapsing across and their trunk swaying across. That is the perfect storm, so to speak, where there is an excessive strain on the knee and it’s too much for the ACL”
Despite all the people at work in the operating theatre, it is a very calm place. You get the sense that is in no small way due to the persona of Moran. When he walks into the room it takes on a sense of stillness. It feels like he has just invited you into his home and he wants you to stay for tea. As part of a documentary we are making for UTV Ireland on cruciate injuries, there was a camera with us, but that was not an issue — all were welcome.
Everyone knows their role in surgery; it’s very much a team effort. Once the graft is prepared by Moran, it is inserted through an incision in the front of Collins’ knee. In the past silk, silver, wire, polyester and carbon fibre were used as a replacement for the cruciate, but now grafts from the hamstring or patellar tendons are most common.
Although the incision is small, seeing anyone being cut open is an uncomfortable experience. The drops of blood that rolled down from his knee seemed like rivers and the smell was almost overpowering.
Moran uses a small arthroscopic camera to look inside the knee. Water is pumped in so the surgeon can see clearly. A blue basin rests on the floor to collect excess blood or water. A screen hangs above the bed showing the inside of the knee. The bones, the joints, the cartilage and the blood. Moran explains his actions and points out where the damage is done and what needs to be repaired. He then secures the tendon by drilling it into the bone, repairing the cruciate.
It’s an efficient, fast-moving procedure; the whole process is completed in just under an hour. Of course, Moran has done hundreds of these operations, so many that he’s lost count, so efficiency is expected.
It is only part of what he does in the UPMC Sports Surgery Clinic but operating on athletes and sports people is one of his favourite parts of the job. Many high-profile victims of the injury have passed through his hands and returned to play and that is a nice feeling.
“Generally with the ACL it is sports people and they are well motivated,” explains Moran.
“People often ask do I not get bored doing so much surgery and you really don’t. It’s all about individuals and getting them back to play. When you are dealing with such a motivated bunch of players it’s pleasant, very gratifying, and very enjoyable.”
In a way, getting involved in sports medicine was serendipity. Of course, when he returned from a fellowship in the United States he was known as Kevin Moran’s brother, and that was OK. He had an instant rapport with patients, a common ground that they wanted to explore, everyone wanted to know how his brother was getting on.
When he started working with the ACL injury over 20 years ago it wasn’t as frequently diagnosed as it is now. Many people believe there is a now a cruciate epidemic but the surgeon isn’t so sure that this is the case.
“We don’t know if there is one. I’m still seeing patients in their 50s and 60s and they have no idea that their cruciate is torn. I’m not saying that it isn’t a common injury but the notion that it is more common than before — we just don’t have data for that.
“I also don’t have the data for the boots, the type of ground, the type of the rotation but we are collecting it. When you look at it, most of these injuries are non-contact rotational injuries, players running along and then a slight change of direction and it is gone.
That player could have done that move 10,000 times and there was never a problem then suddenly it is gone. We are still in the early stages of trying to figure out the whole mechanism; it’s not violent trauma, that’s for sure.”
Of course the increase in sports coverage and also the advent of social media means that more details on players’ injuries are in the public domain. And with high profile players like Colm O’Neill, Colm Cooper and Henry Shefflin suffering the injury, it’s impossible not to be in fear of the dreaded cruciate.
Moran is happy with how Collins’ operation went; there was no evidence of any additional pathology, no damage to the joints or the cartilage. It was a straightforward procedure.
Twenty minutes after the surgery the dual star is awake and sitting up in recovery. Dressed in his hospital gown with the oxygen mask on his face he looks a bit worse for wear. But after a couple of minutes, he perks up. Surprisingly, food isn’t the first thing he asks about. Instead, he wants to know how the operation went and he starts talking about his rehab. He’s not even 30 minutes out of surgery and he wants to get working on his recovery that will ultimately lead to him getting back on the field.
It will be a long journey and he understands the difference between trying to get back as quickly as he can, and not rushing. Roberto Baggio returned to play just 90 days after his ACL surgery in time for the 2002 World Cup. Although his rehab will be done at home in Clare, he will be monitored by the team in Santry. They will also add his details to their growing ACL research database.
With patients like Collins who are enthusiastic and excited about hard work, it’s understandable that Moran enjoys his job, especially when the players get back on the pitch.
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