During their careers, most professional athletes have a string of injuries. They suffer for a bit—or a lot—for glory. During the recent dustup between Floyd Mayweather and Manny Pacquiao, the latter party emerged scathed. He turned to his orthopedic surgeon, Neal ElAttrache, M.D., for advice and ultimately, an operating room. Dr. ElAttrache, who is with the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, tells OTW, “Manny was having shoulder pain during his training period. This was several weeks before the fight…it was essentially an aggravation of an old injury. This is pretty standard for fighters, and there is no such thing as pristine tissue in high level athletes. We treated the aggravation (with permission from U.S. Anti-Doping Agency) and he was back to his normal strength going into the fight.”
Neal ElAttrache, M.D.: Manny Pacquiao Good to Train in 6 Months
“Manny approached me with the question, ‘Is this the type of injury that will heal on its own or will it continue to cause me problems?’ I let him know that a re-injury was possible, and that if this occurred then it would take time away from his training and/or competitions. It is often best to repair a rotator cuff before the tear gets bigger and when patients are younger because then the patient heals better.”
“He wanted to avoid a re-injury, so we proceeded with the surgery. He had healthy tissue and bone and suturing was very easy. We performed a type of arthroscopic repair that I developed…one which has shown to be the strongest type of rotator cuff repair we have today.”
“So far his postop period is going well. He is in the Philippines and I will see him in a couple of weeks. If he wants to continue boxing then I see no reason why he can’t get back in the ring. Our goals for this early phase are for the repair to settle and to avoid damaging the suture tendon portion of the repair. We are allowing early motion, but not enough to stress the repair. Range of motion (ROM) is limited over the first 6 weeks; then we go for full ROM and begin strengthening at about 12 weeks. I will allow him to begin training in 6 months and he should be able to compete in 9-12 months.”
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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