St. Pierre's knee surgery a modern marvel

UFC welterweight champion Georges St. Pierre. (MARIE-CLAUDE FOREST/QMI Agency file photo)

UFC welterweight champion Georges St. Pierre. (MARIE-CLAUDE FOREST/QMI Agency file photo)

DAVE LEVESQUE, QMI Agency

, Last Updated: 9:05 PM ET

He'll never say it, but it probably wasn't an opponent who dealt Georges St. Pierre the biggest blow of his career.

In December 2011, GSP was training for a match against Nick Diaz, which was to take place Feb. 4, when things went south.

On Dec. 7, the verdict was in: The anterior cruciate ligament in his right knee was torn.

St. Pierre required surgery that was expected to keep him away from the octagon for 10 months.

Other than elbow and groin injuries, St. Pierre had been fairly lucky with his health.

"It's a very dangerous injury for me," he said of his knee trouble. "It's a big challenge because it's my first significant injury."

GSP made his concern evident to orthopedic surgeon Sebastien Simard, who diagnosed the injury.

"He called me about 15 times during the day (after the tear was discovered) to ask me if I was sure," Simard said.

Following the surgery Dec. 13, St. Pierre began rehabbing and quickly was able to walk.

"I was wearing a brace but, after a few weeks, I was walking normally and you couldn't tell I was hurt by watching me walk," GSP said.

About 15 or 20 years ago, someone undergoing a similar surgery would have spent a month in a cast.

Medicine has made huge advancements since the 1980s, when arthroscopic surgeries were first done.

"Today, we go to the same conferences and we get information from the same sources," Simard said. "North American medicine is very standardized and treatment options are similar, it's a question of personal preference."

According to the surgeon, surgery is where the advancements have been particularly noticeable.

"Fixing a ligament with arthroscopic surgery takes about an hour and we have time to clean the knee and make sure there aren't any other lesions," Simard said.

At the request of the UFC, which paid the medical costs, St. Pierre underwent surgery in California under the care of Dr. Neal ElAttrache, the doctor for the Los Angeles Dodgers.

The cost of the surgery wasn't disclosed, but the going rate in California is between $35,000 and $50,000. Back in Canada, the problem would have been getting to the top of the waiting list.

"Patients that I meet must wait about a year to have their operation," Simard said.

There is always the private option, which will set you back about $7,000 -- still more affordable than heading south of the border.

• • •

It has been SOME time since a knee surgery required a long procedure under general anesthesia and an even longer recovery time.

"It's often done with local anesthesia with an epidural," Simard said. "It's similar to what we do for a pregnant woman and it lasts about 60 minutes."

A good friend of St. Pierre, the orthopedic surgeon is fond of the arthroscopic procedure. He describes the surgery, which basically amounts to an art form.

First, you have to understand that a ligament is like an elastic and, once broken, it becomes useless.

"You have to take a tendon to replace the broken ligament that is no longer usable," Simard said. "There are three options: The autograft, which comes from the patient; an allograph, which comes from a cadaver; or a synthetic ligament. We had abandoned (the latter) technique and we are now coming back to it."

The synthetic ligament is not always used, but it serves a purpose for specific situations.

"It is good, but in the short-term," Simard said. "It heals fast, but degrades in the long-term.

"We will use it in a situation like with an Olympic athlete going to the Games in a few months and for whom it is a last chance," Simard said. "They accept they will need surgery afterward."

Simard said that 15 years ago, the patellar graft was the treatment of choice and 10 years ago it was the hamstring.

"Now there is a balance and we evaluate each one case by case," he said.

Another big change came with how the graft was installed.

A natural ligament would stick to the femur and tibia, but when surgery is involved, that process needs to be helped along.

"We make a hole in each bone so we can affix the replacement tendon," Simard said. "It is here that there have been a lot of changes.

"Before, we made two tunnels in the femur and tibia to insert the new ligament. According to the studies of Dr. Freddie Fu, we learned that we weren't doing things perfectly from an anatomical point of view.

"We started with the tibia which served as a guide for the femur," Simard said. "Now we do it individually."

Following the procedure, screws are used to keep the tendon in place.

With all of these advancements, the success rate has gone way up.

"Since we have started doing tunnels that are independent from each other, we have jumped from an 85% success rate to 95% of patients who are stable and satisfied," Simard said.

These advancements have also resulted in a much shorter recovery period and fewer future difficulties.

• • •

The biggest danger for an athlete with a knee injury is himself.

"The pain lasts for two or three months, and after that it doesn't hurt," Simard said. "But the healing isn't finished, which athletes don't understand."

Another issue is that athletes are used to living with pain. It goes hand in hand with them having developed an intimate understanding of their bodies.

"Our problem with high-level athletes is that you have to hold them back, but with ordinary people you have to push them," Simard said. "The pros are used to being sore and you have to explain to them why they can't count on their own senses."

What is often ignored is the healing process in the knee following an operation.

"The tendon has to become a ligament, that takes at least six months, no matter if you are an every-day guy or a top athlete," Simard said.

"Sometimes it takes five months, but anything less is difficult.

"While the blood vessels are moving into the new ligament, it is fragile because it has holes like Swiss cheese. It isn't painful and you risk re-tearing, and if you need a second surgery, it takes even longer."

According to Simard, there are few exceptions to the healing process.

If he had to hold back St. Pierre in the past, he believes the champ has received the message this time.

"In the past, I've had problems in the recovery of an elbow of Georges' that I operated on," Simard said. "I think he understands now because it was a catastrophic injury for him.

Georges St. Pierre has surrounded himself with a solid team to keep an eye on his rehab -- starting with his diet.

"I'm using a nutritionist who told me the supplements I needed to take to help me heal," St. Pierre said.

He said he has been using Omega-3 supplements and other things that have a benefit that cannot be explained, but it seems to be working.

"I've made progress, but it can be dangerous to go too fast," he said.

In fact, having a nutritionist around is the tip of the iceberg.

"I'm also counting on two physiotherapists, a doctor and a trainer to heal more quickly," he said.

St. Pierre continues to train for about three or four hours a day, but is doing it differently.

"I'm working mostly on my balance," he said. "I'm doing jazz ballet exercises that are helping and I am focusing on exercises that allow me to strengthen my knee."

And if you just laughed out loud, St. Pierre has a warning for you.

"You can't laugh about ballet, it's a very athletic art," he said.

It is obvious, though, that St. Pierre wants to speed up the process. If all goes according to plan, he could be back in the octagon in November.

But for now he's being patient.

"At the end of March, I started to box again," he said. "Wrestling and contact will wait until July."


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