Dr. Jose Raul Canlas backs medical study in pro league

MANILA, Philippines — Orthopedic surgeon Dr. Jose Raul (George) Canlas of St. Luke’s Medical Center said recently a PBA- commissioned study on the incidence of injuries, particularly involving the ACL (anterior cruciate ligament) in the knee whether in an actual game or at practice would be an aid to establishing protocols in addressing the alarming trend of players undergoing repair surgery and rehabilitation that could take up to 10 months.

In the recent PBA Philippine Cup semifinals, Magnolia’s Marc Pingris and NLEX’ Kevin Alas went down with ACL tears. Dr. Canlas performed surgery on both players who are now on the mend but their period of recovery could extend from six to eight to 10 months. Pingris suffered his injury in Game 1 of the semifinals last March 10 and said the other day he expects to be back sometime in the second week of December.

The ACL appears to be the most vulnerable ligament in the knee among basketball players because of the movements that are inherent in the sport like landing from a jump, sudden stops for pull-ups, twists, cuts and pivots. The physicality in the way basketball is played today also exposes players to the rigors of contact leading to accidents. The ACL is actually two non-elastic, static bands of tissue in the center of the knee that provide stability. There are three other ligaments in the knee but the ACL is the most delicate because it has minimal blood vessels so that a tear entails time to heal.

The arthroscopic operation to repair an ACL tear takes only up to 30 minutes but the recovery to bring the knee back to normal is a long process. Dr. Canlas, a UP medicine graduate who took up his fellowship at the Minneapolis Sports Medicine Center, said determination and discipline are critical in the recovery period. Since returning from the US in 1993, Dr. Canlas has performed over 10,000 ACL procedures and averages about 200 a year. His operation is considered one of the most modern approaches to repairing an ACL tear. He performs a graft, using either a tissue from the hamstring or a patellar tendon, and fuses the “new” ligament with the “old” to evolve a natural bonding that morphs into a stronger ACL, preserving nerve endings and maintaining reflex. Dr. Canlas is probably the only practitioner employing this method in the country and only a handful in the world. Foreign patients from Indonesia, Guam, Vietnam and Hawaii, among others, fly in to be treated by Dr. Canlas who’s the only Asian member in the FIBA Medical Commission.

“Suffering an ACL tear is an accident,” said Dr. Canlas who has participated in the last six Olympics as a medical official. “Because of modern medicine, the injury is no longer career-threatening. The arthroscopic surgery itself is technical and procedural. The difficult part is the rehab.” Dr. Canlas said he estimates an average of three to four players in every PBA team has suffered some kind of serious injury.  

“The best way to prevent the incidence of an ACL injury is to make sure you’re under a proper strength and conditioning program,” said Dr. Canlas. “Exhaustion may also be a factor as with lack of sleep and conditions of play like the court, schedule of games or degree of contact tolerated by the officials. In FIFA, they’ve come up with a standard strength and conditioning program for football players and there has been a marked decline in the incidence of injuries. Personally, I’ve learned a lot from Spanish surgeon Dr. Ramon Cugat, a former FC Barcelona player, a pioneer in arthroscopic surgery and a proponent of PRP. I consider him one of my mentors.”

Dr. Canlas said the PBA could commission a study where details of the incidence of injuries could reveal data that may unlock secrets of how to deal with problems like ACL tears. Asked for his comment, PBA commissioner Willie Marcial said he supports the idea and plans to discuss it further with Dr. Canlas after the Holy Week. Dr. Canlas also suggested more than just a rudimentary cardio-screening protocol to prevent a recurrence of the death of 29-year-old PBA player Gilbert Bulawan at practice.