After a long career in which he has become one of the references for the dressing room and fans, Carles Puyol will leave FC Barcelona at the end of the season. Physical problems have hastened the captain’s departure as they have not allowed him to return to the same level of performance. He has suffered more than 40 injuries, five of them undergoing surgery, since he began his adventure with Barcelona’s first team in 2000, the ones that have given him the most trouble are those that have affected his knees. Especially the right knee is the one that has presented a worse evolution and which has made the player, flagship of the club, decided to leave at 35 years of age.
But are knee operations so complex that they have to be operated on numerous times? Dr. Diego García-Germán, traumatologist and expert in knee arthroscopies, explains the complexity of these procedures: “Puyol had already undergone surgery in 2000 for a traumatic osteo-chondral lesion in the internal femoral condyle of his right knee. In the last 2 years he has undergone 3 more arthroscopies on that knee in less than 13 months including articular lavage, removal of intrarticular free bodies and removal of a Baker’s cyst. This poor evolution, despite all attempts, makes clear the complexity of these injuries, especially in the case of elite athletes”.
Treatments
The traumatologist also spoke about the types of treatments to which the injuries that Puyol has suffered in recent years are subjected:
“In the case of articular cartilage injuries the solution is not so simple nor the results so good. Hyaline cartilage is a highly specialized tissue that lines the ends of bones in joints. This tissue has a very low coefficient of friction, which allows the gliding of one articular surface over the other. Its thickness is minimal, around 2-4 mm.
Like other highly specialized tissues (the nervous tissue in the brain or spinal cord) its capacity for repair is minimal, as the cells have almost no capacity for division. This means that the treatment of articular cartilage lesions continues to be the great problem of orthopedic surgery.
Currently there are several treatments to try to correct these cartilage defects. These include surgical stimulation techniques such as microfracture, mosaicplasty (transplantation of osteochondral tissue from one area of the knee to another) and chondrocyte culture. These techniques are valid in focal lesions but the results are not as good in extensive lesions. The result may be a tissue similar to native hyaline cartilage but not exactly the same, with worse mechanical properties (due to its low collagen type II content).
Infiltrations with various blood-derived products (mainly platelet-rich plasma) is a promising option for the early treatment of chondral lesions and may offer clinical improvement, although the healing of extensive chondral lesions is not very realistic”.
Will Puyol be able to play again?
According to Dr. García-Germán, it will be difficult for Puyol to play again in elite soccer: “The condition of his knee will probably allow him to lead a normal life and even play light sports, but obviously it will not allow him to play soccer at the level to which he was accustomed, which is necessary for a player of his category”.