Dr Cruciate: Surgeon Ray Moran on growing up with his famous brother Kevin and getting the cream of Irish sport back on track

The Big Interview: Surgeon Ray Moran talks about getting Jon Bon Jovi back on stage, growing up alongside his famous brother Kevin, working with the cream of Irish sport and getting them back on track plus why surgery is not always the best option and how doctors should treat the patient, not the scan or the X-ray…

This article by Michael Verney was published in the Irish Independent on May 30th 2020. Photos by David Conachy.

The moniker of being ‘surgeon to the stars’ is taken to a different stratosphere when a name like Jon Bon Jovi is thrown into the mix and the rock star is just one of thousands who have come under the watchful eyes of Ray Moran.

Patient Confidentiality prevents him from documenting most of the clients who have passed through the doors of the Sports Surgery Clinic (SSC) in Santry but standing proudly in the corner of his office is a glowing testimonial from the music icon.

The Bon Jovi frontman was “Livin’ on a Prayer” when he heard a pop and blew out the meniscus in his knee halfway through a concert in front of 40,000 screaming fans in Helsinki nine years ago only for Moran to quickly ride to the rescue.

Referred by American doctor Steve O’Brien after initially being advised to cancel his European Tour and leave his adoring public heartbroken, Bon Jovi made a swift transfer to Dublin and was back on stage a week later. Everything was a bed of roses again.

“The doctor suggested I consider postponing six weeks’ full of stadium shows across Europe. But the knee bone is not connected to the singing bone, my dear doctor. Surrender was not an option and eight days later I was back on the stage jumping around once again,” his tribute reads.

It was a routine procedure for the vastly experienced Moran and he never missed a beat as he did what he does best with “the easiest patient”.

 

 

“He was funny. He came in and he was like, ‘Hey Doc, this knee I’ve got to get it sorted Doc, I’m on stage in eight days’ time in Athens, gotta fix it Doc, they told me to cancel 80,000 fans Doc’. I was like, ‘What are they on about? We got it’,” Moran recalls.

“He was in and it was bang, bang, done. The easiest patient, a little bit like the elite athlete, he knew exactly where he wanted to be, like someone targeting a match, they’re probably going to make it unless there’s some overwhelming reason not to. They won’t be going, ‘No, I’m too sore’. Motivation is everything.”

Moran got an early taste for the company of greatness growing up in Drimnagh alongside his younger brother Kevin, who shot to fame winning two All-Ireland SFC titles with the Dubs in the 1970s before going on to star for Manchester United and Ireland, winning 71 caps for his country.

Kevin’s remarkable talent sent Ray, who is two years his elder, into “early retirement” as regards his playing days but the affinity he garnered for sportspeople along the way – as well as having a famous brother that people regularly inquired about – helped to pave the path for an extraordinary career in orthopaedic surgery.

“We had a little garden out the front with a set of goalposts and we’d play a little bit of football but it’s very hard for an older brother to look at a younger brother and say, ‘He’s a special talent’. In fact, you’re in denial.

“We’d be kicking balls in from the side and heading them and you’d be in goal and when Kevin headed the ball it was like it had been kicked full speed. So you’d stand in goal and be like, ‘No you moved too early’, or there’d be some technical objection to make him do it again.

“There was an assumption then when I started in practice and saw patients that I would have empathy because I was Kevin’s brother. I remembering doing a ward round in Beaumont (Hospital) way back when and there was a young fella in his bed.

“People were slightly formal and it was ‘Dr Moran’ or ‘Mr Moran’ but this young fella in his mid-teens looks up and says, ‘Howya Ray, how’s a going? How’s Kev?’ They weren’t looking at you as the white coat man, they assumed you weren’t some high high-falutin looking down on them and ‘you’re one of us’.”

Moran specialises in everything related to the knee – particularly cruciate ligament surgery – and having founded the Sports Surgery Clinic in 2007 and “ridden out the storm” of the financial crash in its early years, he has watched it grow beyond recognition with over 500 people now employed at their Santry base.

His list of patients reads like a who’s who of sport with Kerry football legend Colm ‘Gooch’ Cooper, former Dublin star Bernard Brogan, Tipperary hurler Brendan Maher, Leinster and Ireland rugby flanker Josh van der Flier and world-renowned stunt driver Mattie Griffin just a handful of those who have gone under his knife.

Clare hurling captain John Conlon was one of the last patients to negotiate surgery on a ruptured ACL (anterior cruciate ligament) before lockdown hit and Moran relishes dealing with elite athletes.

There have been some miraculous recoveries following his handiwork with Brogan returning in 23 weeks but former Munster and Ireland back row Alan Quinlan reckons he boasts the record having trained fully five months after cruciate surgery and played just two weeks later.

There is “a strangely personal” connection built up between doctor and patient, though, and Moran is not a good spectator. Instead, he prefers to hear or read about their success.

“I still find it almost easier not to watch it. When players come back for key games, if you’re watching it you’re almost like a relative, you’re following everything and wincing and it’s almost selfish from a surgeon’s perspective,” he says.

“You love to hear when so and so returned and you make sure that they weren’t substituted and that they went through the game. You’d have a fantastic fascination and when you’re dealing with players, it doesn’t matter what county, it’s all about the player.

“You want to see them play well and I’m a supporter of so many counties. People often ask, ‘What kind of loyalty is that?’, but you’re thrilled and delighted when you see guys back and playing at a good level.

“Dealing with people like that is a pleasure and an honour because they’re focused. We do assessments after surgery and when you’re dealing with athletes like that, you get these results back and you’re saying, ‘Wow’.

“How come the really talented athletes tend to be the best? Well, they tend to be the hardest working too.”

Known as Dr Cruciate for his unparalleled expertise in that area, Moran “will never tire of working with motivated patients” but the coronavirus pandemic has brought his creation – for which Kevin is also a board member and shareholder – to a standstill. With the Dublin 9 clinic taken over by the HSE, it gives him some rare time to reflect. Interviews are scarce as he wouldn’t have the time given that he oversees around 600 surgeries per year – bigger numbers than anywhere in the world – spread over Tuesdays and Fridays with the cruciate operation taking roughly an hour.

There’s normally a massive waiting list for his services with spring and summer a hive of activity as cruciate injuries are most common during that time given the torque and twisting in sports like GAA, rugby, soccer and basketball.

Silk, silver, wire, polyester and carbon fibre have all been used to replace the cruciate in years gone by but grafts from the patellar tendon (knee), his personal preference where possible, the hamstring and the quadriceps are most common now as sports science continues to advance.

Young Hurler of the Year Adrian Mullen and Limerick’s All-Star defender Richie English are two of many to have suffered the dreaded curse of the cruciate – which usually requires at least nine months on the sidelines – already this year but Moran doesn’t view sport as some sort of “kamikaze mission”.

Yes, there is an increased risk given that the cruciate is “a modest ligament” being put under more pressure than it is constructed to absorb but he doesn’t consider it to be an epidemic.

“We’re biologically not rotational animals. What we’ve evolved to in terms of normal on earth day-to-day activity, be it hunting or whatever it was, it would be more than adequate for that. But when we brought sport into the picture, that wasn’t part of the evolutionary process,” he says.

“So next thing something happens to your cruciate and it’s like, ‘Oh my God’, and that’s the long and short of it. Animals have better ACLs than we would. The mountain lion, for example, has a triple-bundle ACL, very sophisticated because it has evolved. If it slips off a cliff edge, it’s gone. That’s evolution and nature. We wouldn’t have too many knee problems if we just walked the dog but that’s not where we want to be and we don’t want our body to be perfect as we sign off. Torque rotation will always have a risk factor because it’s basically doing something that we’re not necessarily designed for.

“All of our preventative treatments are dealing with a situation that puts a demand on the knee but we have to accept that and work as best we can to minimise the injury rates. People’s fitness levels have gone up so much that people think there’s an incremental increase in the injury rate.

“I’m not sure about that, we don’t have stats to compare this with 30 years ago. I would still see patients that would come into me in their 50s, 60s, 70s and 80s and they’ve torn their cruciate and had an injury way back and I’ve seen plenty from then that didn’t even know they had it.”

What pleases him most is results of extensive research carried out at SSC (which was published in the American Journal of Sports Medicine) highlighting that a two-year follow-up on nearly 1,500 patients resulted in over 80 per cent returning to competitive sport after cruciate surgery.

The development of 3G (Third Generation synthetic) pitches and other all-weather surfaces is often blamed for a spike in injuries but he is “not quite sure if the artificial surfaces are as guilty as they are made out to be”.

Regenerative

Moran is keen to pour cold water on the benefit of stem cell treatments, though, as he operates on the maxim of “numbers, numbers, numbers” to reinforce his practice and he doesn’t believe the evidence is there to support such regenerative medicines.

“People sometimes say have you tried stem cell? I say, ‘Hang on guys, where’s the data?’ You have to look at data in relation to it because there’s a lot of funny stuff. You have to be data-driven, you have to be able to collect your data both orthopaedically and in sports medicine,” he outlines.

“You have to be able to stand over the results and say they are verifiable as opposed to, ‘Why don’t you try this or that?’ It’s a disappointment really. We were looking at bringing the programme here because it’s exciting, front-foot stuff but let’s look at the data first and foremost.

“They get some results saying patients feel a bit better after a year or two but there’s no studies that show that stem cells regenerate articular cartilage, none. If you image the knee a year later, it will show no evidence that the defects have been filled so that’s not very encouraging.

“You have to make sure that you’re not being hoodwinked or that you’re not doing change for change’s sake,” he adds. “I don’t think we should be imposing ourselves as much on the body and trying to tweak it. If you get too clever with it, it can bite back.”

With players often eager to return to full health as soon as possible when sidelined, there can be a temptation to go for surgery as a quick-fix to get back in the mix but Moran always puts himself in the patient’s chair.

‘Do unto others as you would have them do unto you’ is his philosophy and with his average patient being “middle-aged and playing golf or working out or doing hill walks”, he gasps at clients being advised to go under the knife based on X-rays or MRIs, rather than reality.

“I’d say 95 per cent of people that tell me that they were told they’d need a hip or a knee replacement in 10 years, it turns out not to be the case. I’m always astonished by the number of people that tell people that and I sometimes give them a second opinion and I’m like, ‘What? Where are you saying this?’.

“Because it’s something on an X-ray – go way out of that. ACLs all show some wear and tear but how many end up with joint replacements? Bugger all. I’ve seen people abandon things because of advice they didn’t need to have. If you have an injury, a bit of wear and tear, and you’re able to comfortable do whatever, then comfortably do it.

Rush

“There’s very little data to suggest otherwise. It’s a quality of life issue and if I see a patient coming in to me after three months. I’ll say, ‘That’s too early, there’s no rush’. Operate on the patient, not the scan or the X-ray.

“I remember looking at a knee and saying, ‘You must be really suffering with that’, and they went, ‘Ah, a bit stiff Doc’. It’s not a wimpy factor or tolerating pain well, it’s a level of biology. We’re at the foothills in regards to the overall explanation of the human body and it should keep us humble because it will forever surprise us.”

Moran craves “the competitive edge” of surgery and is itching to get back in action after lockdown. It enthuses him to leave his Rathgar home early every morning to beat the traffic and work “seven to seven” with over 30 years in medicine not dimming his passion one iota.

Zoom meetings are a decent alternative during unprecedented times but he can’t wait to “see the whites of the eyes” of his patients, all part of getting to know the people that place their trust in him. A round of golf in the Castle golf club last week was a nice change of pace but there’s nothing like the operating theatre.

He craves the endorphins which dealing with the elite brings and the SSC has attracted athletes from far afield like Spain, France, Italy and Australia with several AFL players making the 35,000-km round-trip to be in their care. Head of sport and high performance Enda King has overseen the development of a 10,000-sq foot Sports Medicine department which is in a league of its own, catering for 240 patients per day pre Covid-19.

A fellowship to the US in his younger days blew Moran’s mind and he returned with lofty ambitions. Little did he think that it would “go places that I never saw it going to” and it’s now a one-stop shop for the full array of sporting ailments.

It’s currently valued at over €60million but “it never felt like work” to Moran and he has his eyes on luring Premier League footballers to Santry as “there’s never an end point” with the next goal around the corner.

One thing is for certain, any patient who comes in contact with Moran will be in the safest hands of them all – thousands will attest to that.

Indo Sport

For further information on ACL Repair or to make an appointment with a knee specialist at SSC please contact info@sportssurgeryclinic.com 

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