Manuel Leyes: «Collagen does not regenerate cartilage»

Wandering around Manuel Leyes’ unit at the Olympia clinic in Madrid is like walking through a kind of ‘walk of fame’. Its walls are covered with t-shirts of athletes who have become legends such as Zinedine Zidane or with some special souvenir from his famous patients: Samantha Vallejo-Nágera’s kitchen jacket, Ara Malekian’s violin bow or one of the electric guitars. . from Café Quijano. Always framed and accompanied by a phrase of gratitude for having treated them. —Is a famous cure the best marketing to fill a doctor’s office? –I suppose the patient will be reassured to see that an athlete trusts us. But we don’t do it looking for any publicity. All this started little by little. When other athletes saw each other’s shirts they began to bring back more memories: a glove, a racket, a signed photo… It is a form of gratitude from the patient. I also have scissors from an unknown hairdresser who gave them to me after having used them his entire life. Even if all these memories were hidden in my house, I would love to have them, I am a very mythomaniac. —And as a mythomaniac, who has left the most mark on you? —The mountaineer Carlos Soria. He is exceptional and one of the athletes he admires the most. It’s incredible that at his age he still wants to do things, to climb ‘eight thousand’. He is an example of enthusiasm, of the desire to live and of everything that can be done with a prosthesis; There is life after it. I also really admire gymnasts. I have been with the gymnastics federation for 25 years and I know very well the effort and dedication that a sport with so little visibility requires. Related News standard No Cryotherapy: know the benefits of being at 110 degrees below zero SM standard No CASTILLA-LA MANCHA They perform a novel knee cartilage repair technique with biological material from patient ABC —His professional career is linked to sports medicine Can all patients be treated like elite athletes? —You have to adapt it. The professional athlete has all the time in the world to worry about his injury and has all the technological and professional means available to him. The rest has to continue with his life. That is why we are trying to shorten recovery and admission times so as not to alter the lives of patients. When I started in prosthetic surgery, a patient needed to be hospitalized for at least a week. This has been shortened to an average admission of about three days and the next step is outpatient surgery, although in Spain it still sounds strange. A great revolution is happening in the United States. In sports surgery, almost 90% of the interventions are done without admission. —You were the first to perform the first total knee replacement on an outpatient basis. His patient was operated on in the morning and in the afternoon he was already at his house. How was the process? —We did it in October. It was the first time it had been done in Spain, but not in the world. In the United States and other European countries it has been done for a long time. Our first case went very well. The patient had no pain until the third day of surgery and there were no complications. We gave him a triple anesthesia: an epidural, a local anesthesia and at the end of the operation a sensory block in the abductor canal. This is how we got him to stand up after 3-4 hours and walk without any pain. Then we let him go home with a cryocompression machine so that he doesn’t have any pain at his home. The follow-up was done with a video call and on the third day we began the rehabilitation. «The mountaineer Carlos Soria is one of the athletes I most admire. It is incredible that at 80 years old he still wants to climb ‘eight thousand’ »—It would save costs for the health system. Why isn’t the technique more widespread? —Unfortunately, it cannot be done with all patients. Surgical and medical criteria must be taken into account. It is not a question of age but of health. Candidates must be people with few chronic diseases or, if they exist, they must be controlled. Even so, there are patients who prefer to stay in the hospital because they are afraid of the pain, of what could happen at home. In the United States, Medicare doctors, for example, have to justify why a patient with a prosthesis should be admitted to the hospital. —Are the advantages only economic? -No. You eliminate the typical complications of an admission, such as hospital infections. You move sooner and you end the risk of deep thrombosis. Furthermore, the patient is in his family environment and does not alter the family logistics. If it spreads in public health, waiting lists could be reduced. Manuel Leyes, with a reproduction of a knee joint José ramón ladra —Regenerative medicine in traumatology began to be tested in private medicine using plasma rich in growth factors. Does it really work? –It is still used. What you achieve with growth factors or hyaluronic acid is to reduce pain and delay the implantation of the prosthesis for a while. I have not seen cartilage regeneration in my patients, but there are patients who notice temporary relief. –And the supplements sold in pharmacies? Does taking collagen help? —We know that they do not regenerate cartilage, but some patients notice some relief when taking glucosamine, collagen… I am not against them taking it because it is not harmful, but it is true that it is not very predictable. There are patients who improve and others do not improve at all. The truth is that when the degree of wear of the joint is advanced, the only thing left to do is replace the joint with a prosthesis. Today they have improved a lot compared to what we had before. Robotic surgery can be used to help us be more precise when implanting it and does not allow us to fail. — Will we ever say goodbye to prostheses? —I would like to think so, although I see it far away. I have been dedicated to this for 30 years and it is always talked about, but each year we put in more prostheses than the previous. —The artificial intelligence that will revolutionize almost everything, how will it benefit knee surgery? —It will certainly have an impact. With the data analyzed by the AI, we will be able to know what the results have been like in similar patients depending on the alignment we have given to the prosthesis. Based on a huge pool of patients, we will know what would be the best way to implant the prosthesis or the best model. It will be a great help, without a doubt.