Dr. Pascal Serge Christel is one of the premier orthopedic surgeons in France. In addition to running his own private practice, he serves as Professor of Orthopaedic Surgery at Paris 7 University and as Secretary General of the French Society for Arthroscopy. His fields of specialty include sports medicine, arthroscopy, and knee surgery.
Knee1: Could you take me through a typical day?
Dr. Christel: Most days start at 8:00 am. Usually I start with surgery or outpatient clinics. When I do surgery, usually I am there all day, from 8:00 am to 8:00 pm and I perform 10 surgeries. The type of surgery I perform most often is knee surgery to treat sports injuries.
Knee1: Are most of your patients athletes? What is the most common way they injure their knees?
Dr. Christel: Yes, most of my patients are athletes. In France, the two main reasons for an ACL tear are soccer and skiing accidents. I deal mostly with athletes who practice judo and I am working with the team physician of France’s national judo team. Judo is very popular in France. We have 500,000 licensed players, and at the last Olympic games we won six medals.
Knee1: Do you notice a difference in the incidence of knee injury between men and women?
Dr. Christel: It depends upon the sport, but there are slightly more women than men with knee injury.
Knee1: But once you repair the ACL, these athletes can get back to top form?
Dr. Christel: It takes at least one year before they can go back to high-level competition. It doesn’t mean that they are at their best level after one year, but they can go back to international competition.
Knee1: Do you work with these athletes over their year of rehabilitation and training?
Dr. Christel: Yes. I follow them very closely after surgery. During the first six months, it is usually okay; they come back for clinics. But after six months, when their knees start to feel better, they do not understand why they should come back to the doctor’s office. We lose a lot of these patients after six months. It is a constant fight between these athletes and the doctors for medical follow-up.
Knee1: How have your knee surgeries evolved over the past few years?
Dr. Christel: Techniques are much more accurate now than they were ten years ago. We have more knowledge and better instruments. I think we still have a lot to learn.
Knee1: Aside from athletes, what other patients do you see in your practice?
Dr. Christel: I like to see myself as a vertical knee surgeon. I take care of everyone from kids to the elderly. So I am doing sports medicine cases, I am taking care of children’s knee cases, I am performing knee replacements, all kinds of surgeries.
Knee1: PCL tears occur less frequently than ACL tears. Why does this happen?
Dr. Christel: The PCL is a stronger ligament. To tear the PCL, you also need a lot more energy. Depending upon the place you are working, you may see PCL injuries after traffic accidents or after sports. Fifty percent of the cases are secondary to traffic accidents, and the other half are secondary to sports injury.
Knee1: What is the benefit of PCL surgery?
Dr. Christel: Most tears in the knee are ACL tears. One PCL tear occurs for every ten ACL tears. With the PCL tear, you do not have immediate problems. For maybe 20 years, the patient will not complain of an injury. Compared with ACL, it is much less frequent. Very few orthopedic surgeons take care of the PCL because it is much more difficult to reconstruct than the ACL. Because it is not a frequent surgery, very few surgeons are trained in it. By chance, I was involved in this field in the mid-1990s and now I’m doing about 30 cases per year.
Knee1: Is the rehabilitation period longer for a PCL reconstruction?
Dr. Christel: Yes, it is much longer. In fact, it takes about twice the time as ACL rehabilitation.
Knee1: What is your most important contribution to medicine?
Dr. Christel: My most important contribution is the use of bioabsorbable materials in orthopedic surgery. I was one of the inventors of the use of bioabsorbable metals. Twenty-five years ago, in 1976, we got the patent describing the use of polylactic- and polyglycolic acids for the manufacturing of internal fixation implants, like plates, screws, pins, etc. This is a big contribution because for the first 18 years, no one else can use your patent unless they pay royalties. Companies could not work around our patent because it was so broad. After 20 years, all the competitors came to market with similar products.
Knee1: How did bioabsorbable materials change knee surgery?
Dr. Christel: It changed surgery because the surgeon does not have to remove the hardware. When you use a nonabsorbable material, sometimes patients complain of pain from the friction between the hardware and knee tissue. In those cases, the surgeon must remove the hardware in secondary surgery. Even though the surgery is not complicated, the patients and surgeons do not like to go through it. So when you use bioabsorbable materials, you do not have to go back to remove the hardware. Also, with a sophisticated imaging technique such as magnetic resonance imaging (MRI), if you use metal implants, you do not get good images because of artifacts that are generated by the metal implants in the magnetic field. If you use plastic or bioabsorbable implants, then you are okay. You can get very good images. With bioabsorbables, you do not have corrosion or local toxicity. You may have other problems, but not the problems you have with metal implants.
Knee1: Are bioabsorbables popular now that the patent has expired?
Dr. Christel: Bioabsorbables are widely used in several countries, more in Europe than in the United States. They are standard tools in the implants that we do. It’s a cultural reason they are not used in the United States at the same extent.
Knee1: What would you like to see yourself doing over the next ten years?
Dr. Christel: I would like to turn my activity exclusively toward knee surgery. There are many problems to solve, such as cartilage repair and meniscal repair. Right now we are able to achieve things in meniscal repair that we were not able to achieve 15 or 20 years ago, but we still have a certain percentage of failures. We are constantly working to improve the materials, to improve the devices, and to improve our techniques. Saving the meniscus and repairing the cartilage raise a key issue for the future of the knee. If you want to avoid long-term changes, you have to be very careful with the meniscus and cartilage.
