After three operations allowed him to return to action for the 2021 campaign, it became clear that his arm still wasn't right and he was being severely limited on the bike.
Something that prompted thoughts of retirement - as an emotional Marquez lays bare in Amazon's docuseries Marc Marquez: All In, which releases on 20 February - he underwent a fourth operation last summer to have his right humerus rotated over 30 degrees back to its original position.
The person in charge of preventing Marquez from hanging up his overalls at the age of 29 was Doctor Joaquin Sanchez-Sotelo, a surgeon at the Mayo Clinic in Minnesota, with whom Motorsport.com's Spanish language site had the opportunity to chat this week.
Motorsport.com: How did Marquez's approach to you for the surgery come about?
Dr Joaquin Sanchez-Sotelo: "Marc had needed three previous surgeries in Spain. Two in Barcelona and one in Madrid. The last one was performed by Dr. Samuel Antuna, who is well known both in Europe and in the United States. He called me and told me that, in spite of having resolved the infection [which Marquez suffered following his second operation and necessitated his third], Marc had mobility problems, basically external.
"In the first instance I advised him to give himself a few more months of margin, to try to improve as much as he could. After that time, he told me that he still couldn't control the bike when cornering, and that he also had problems when braking. He couldn't lock his arm, it was going inwards. Marc sent me a CAT scan of both arms. Thanks to 3D printing, we reproduced his two humeri in plastic; the left one and the injured one, which had considerable rotation. We had a video call, I showed him the bones and he said, 'I'm having surgery.'"
Q: Why did you have to travel all the way to the United States?
JSS: "In orthopaedic matters, as the complexity of the surgery increases, it is important to find someone who has a lot of experience in that particular field. What is unique about the Mayo Clinic is the specialisation. I do just shoulder and elbow, and I do a lot of that. But it's also that I have a lot of devices and resources at my disposal that are hard to get elsewhere. The 3D printing department is spectacular. I sit down with an engineer and we plan and project the procedure on a computer, print cut lines and so on."
Q: How many operations of this type have you done before?
JSS: "Marc's operation is infrequent, and I do them once or twice a year. Basically, because patients to whom the same thing happens, and their bone has a similar rotation, adapt to daily life. If he were a soccer player, he would probably have adapted to playing with his arm that way. But, for example, it would have limited him in an action as simple as washing his hair.
Q: What is the mirror technique?
JSS: "The human body is very symmetrical. A person's right humerus is identical to the left. For an operation like the one we did on Marc, it is very useful to make a scan of the healthy side, and the computer programme is able to make a mirror image. It is then 3D printed, so the surgeon sees what that bone looked like before it was broken. When one wants to reconstruct a bone to leave it as it was before an injury, this is extremely useful. Because, in addition, this technique makes it possible to design sterile plastic cutting templates that are fixed to the bone. Thus, both the cut and the rotation are very precise."
Q: Are there any limitations?
JSS: "Marc has such a great capacity for sacrifice that I don't think he has any limitations. I think the previous operations on his shoulders [after the dislocations he suffered] will cause him more problems than this last one. From the medical point of view, the humerus is as it was before he fell. The only doubt I have is whether he has any apprehension about getting on the bike. But, knowing the person a little bit, it seems to me that the mental part is quite under control."
Q: What would you highlight about him as a patient?
JSS: "He has two very good characteristics. The first is that he trusts the opinion of the professionals. What he wants is direct and clear communication. And then, he puts his all into everything he does. You have to know that if you let him do push-ups, he will do not one, but a hundred. He told me to only let him do certain things when I was sure he could safely do them again."
Q: In the documentary it is clear that the root of the whole problem was the haste that led him to try to race in Jerez, after the first surgery. To what extent did you keep that in mind?
JSS: "I told Marc that I couldn't compromise that fourth surgery because I was in a hurry. And he told me yes, that obviously he understood. He was sorry. But, at the same time, he also made it clear to me that, as soon as I gave him permission, he would go all out."
Q: Did you ever see him doubt that this fourth operation was the best solution?
JSS: "When he saw the 3D image of the two humeri, he realised that the best option was to have surgery. That is very visual evidence. As soon as it became clear to him that there was a possibility of improvement, he told me that he was getting on a plane and that he was coming here immediately. He was very brave, because when you tell a patient who has broken his arm that you are going to cut it off again, most of them tell you that you are crazy. It was the only way to do it."
Q: And did you discuss the odds of it going wrong?
JSS: "What helped me a lot was to plan the case with extreme care and attention. Other surgeons who had seen him before had recommended that I make the bone cut in the same place where there had been the previous fracture. And that, from my point of view, was riskier because there had been infection inside the bone. I looked for a way to try to make the surgery as minimally invasive as possible, the least risky. The bone is a cylinder, so I decided to make the cut a little higher to limit the risk of complications. Although in an operating room there can always be problems, I had the feeling that it was going to work. Of course, the night before the operation I did not sleep a wink. I was thinking, 'oh my God, I hope everything goes well.'"
