“Doc, is it true they call you Doc because you are training to be a doctor?” asked the venerable Rangers coach.
“Er, yes, that’s absolutely true,” replied the youngster.
“Son, I’ve been watching you train and play and I think a career in medicine beckons,” said Smith.
Football’s loss has been sport’s gain. With a mother who was a GP in Drumchapel and a father, Alistair, who played professional football for Kilmarnock, sport and medicine were always the twin tracks of Mackay’s life. During his time at Rangers, however, he witnessed the debilitating psychological impact of chronic injuries and quickly came to understand the seismic impact injuries could have upon the careers of sporting professionals.
Armed with that knowledge, and following a spell Down Under where he saw the phenomenal levels of expertise of the sports medicine specialists treating Aussie Rules players, Mackay went on to become the country’s most feted sports surgeon. Having worked with Rangers, Celtic, the Scottish Rugby Union and the Scottish Institute of Sport, amongst others, he has long been the go-to man for Scottish sportsmen with career-threatening injuries. A recent innovation has, however, elevated him to the status of one of the most eminent sports physicians in the world.
That fact is down to a remarkable technique known as internal bracing, which was invented by Mackay and has the potential to fast-track professional sportsmen and women back from injuries that were once potentially career-ending. The breakthrough stems from a hunch Mackay had that he could improve upon the standard ligament surgery in which detached ligaments would be stitched back on to the bone, meaning around six months in plaster to inhibit movement. Once the period in plaster was over, the athlete would then need intensive rehab because he or she would not have used the muscles in the leg or arm for an extended period.
“I reasoned that it must be possible to support and stabilise the knee using some sort of internal brace – essentially a tiny bungee cord doing the job of the ligament – so I went out to see if that would work in practice,” he says. “I teamed up with a big pharmaceutical company which had developed a polymer for use in the rotator cuff of the shoulder and found that, by attaching it with biological screws to the bones to which the ligaments should be attached, it would take the strain on behalf of the ligament. This means that the injured athlete wouldn’t have to be in plaster, would be back doing light training very quickly and would therefore be back competing much more rapidly than using conventional methods. It is also good for the athlete’s long-term health because the ligament is free to reattach itself naturally using the lattice-work structure of the polymer brace, which is what the body wants it to do, so there’s none of the scar tissue or the arthritis which usually follows if the ligament has been artificially reconstructed.”
Mackay’s breakthrough is an innovation that has put Scotland on the map in sports medicine. Two weeks ago the surgeon was in Naples in Florida, lecturing to an annual convention of the world’s top ankle, knee and shoulder surgeons on the subject of the internal brace. A relatively simple procedure, despite being only three years old it’s already being used extensively in the USA where knee injuries in particular have become increasingly commonplace as American football players have got bigger and more muscular, meaning bigger hits on the increasingly vulnerable joint areas which cannot be bulked up or made stronger. “Of all the joints, the knee is the most vulnerable because four or five times your bodyweight goes through it,” says Mackay. “Two thirds of knee injuries don’t involve any other player so, as players get heavier and faster, the pressure on knees increases all the time – it’s basic Newtonian physics.”
However, if Mackay’s internal brace is making waves in the NFL, it’s also being noticed closer to home. When Theo Walcott injured his anterior cruciate ligament against Spurs, the recovery time of the conventional treatment means that the England striker will miss the World Cup. Such was the furore that Arsenal doctor Gary O’Driscoll, a former Ireland rugby team doctor and cousin of Ireland skipper Brian O’Driscoll, who knew of Mackay’s innovation through the two men’s rugby connections, has considered whether or not to use the internal brace in an attempt to get Walcott back playing in time for the showpiece tournament in Brazil.
“I think that, as with Theo Walcott, anyone looking to cut down on the rehab time for a player who has sustained serious knee ligament damage would be interested in the internal brace technology,” says Mackay. “If anyone doubts its capacity to repair damaged ligaments or tendons, they only have to take a look at the bobsleigh event at the Winter Olympics in Sochi to see what can be achieved.”
Mackay is talking about the case of John Jackson, a British bobsleigh pilot who completely tore his Achilles tendon while jumping a hurdle in training in August. The 36-year-old was told that a conventional operation would mean that he would still be lame when the Games kicked off in the first week of February. Instead, he did some research and came across Mackay’s pioneering technique. With nothing to lose, he took the plunge and, instead of being out for a year and in plaster for months, he was doing light exercise within weeks and was back to full sprinting within five months, joining up with the British team in plenty of time to take his place at Sochi.
“I’ve been working in the field for 23 years and have never seen improvements like this,” said Dr Rod Jaques of the English Institute of Sport. “I’m astounded – the milestones he’s hit so rapidly are phenomenal, although we can’t say this is the golden solution for Achilles tendon ruptures just yet because the proof will come ten to 20 years down the line.”
For both Jackson and Mackay, however, the reward will not come in years but in days, when Jackson takes to the ice in Sochi. “There’s been a real intellectual satisfaction to inventing the internal brace,” says Mackay. “But that’s nothing compared to the emotional buzz I’ve got from knowing that Jacko is able to attend a Winter Olympics and fulfil a lifetime’s dream because of something I have done. The only thing that beats that is the knowledge that he is just the first of many.”
• An injury to the anterior cruciate ligament can be a debilitating musculoskeletal injury to the knee and is seen most often in athletes.
• Non-contact tears and ruptures are the most common causes of ACL injury. Injuries of the ACL range from mild, such as small tears, to severe when the ligament is completely split in two.
• Tears in the anterior cruciate ligament often take place when the knee receives a direct impact while the leg is in a stable position.
• These types of injuries are prevalent in alpine skiing, football, American football, basketball, rugby, professional wrestling, martial arts, and artistic gymnastics.
• An ACL tear can be diagnosed by a popping sound heard after impact, anterior knee instability, swelling after a couple of hours, severe pain when bending the knee, and when the knee buckles or locks during movement or gives way while standing still with weight on the affected knee.